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Shekhar S, Ajay A, Agrawal A, Kumar A, Kaur M, Isogai T, Saad A, Abushouk AI, Abdelfattah O, Lak H, Farwati M, Ahuja K, Verma BR, Wunderle K, Ellis S, Khatri J, Ziada K, Krishnaswamy A, Kapadia S. Radiation reduction in a modern catheterization laboratory: A single-center experience. Catheter Cardiovasc Interv 2022; 100:575-584. [PMID: 36073017 DOI: 10.1002/ccd.30396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/31/2022] [Accepted: 08/18/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Measures were undertaken at the Cleveland Clinic to reduce radiation exposure to patients and personnel working in the catheterization laboratories. We report our experience with these improved systems over a 7-year period in patients undergoing diagnostic catheterization (DC) and percutaneous coronary interventions (PCIs). METHODS Patients were categorized into preinitiative (2009-2012) and postinitiative (2013-2019) groups in the DC and PCI cohorts. Propensity score matching was done between the pre- and postinitiative groups for both cohorts based on age, sex, body surface area, total fluoroscopy time, and total acquisition time. The effectiveness of radiation reduction measures was assessed by comparing the total air kerma (Ka,r ), and fluoroscopy- and acquisition-mode air kerma in patients in the two groups. RESULTS In the DC cohort, there was a significant reduction in Ka,r in the postinitiative group in comparison to the preinitiative group (median, 396 vs. 857 mGy; p < 0.001). In the PCI cohort, Ka,r in the postinitiative group was 1265 mGy, which was significantly lower than the corresponding values in the preinitiative group (1994 mGy; p < 0.001). We also observed a significant reduction in fluoroscopy- and acquisition-based air kerma rates, and air kerma area product in the postinitiative group in comparison to the preinitiative group in both matched and unmatched DC and PCI cohorts after the institution of radiation reduction measures. CONCLUSION There was a significant and sustained reduction in radiation exposure to patients in the catheterization laboratory with the implementation of advanced protocols. Similar algorithms can be applied in other laboratories to achieve a similar reduction in radiation exposure.
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Affiliation(s)
- Shashank Shekhar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abhishek Ajay
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ankit Agrawal
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anirudh Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Manpreet Kaur
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Anas Saad
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Abdelrahman I Abushouk
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Omar Abdelfattah
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hassan Lak
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Medhat Farwati
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Keerat Ahuja
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Beni R Verma
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kevin Wunderle
- Department of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stephen Ellis
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaikirshan Khatri
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled Ziada
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Chaosuwannakit N, Makarawate P. Diagnosis and prognostic significance of anomalous origin of coronary artery from the opposite sinus of Valsalva assess by dual-source coronary computed tomography angiography. IJC HEART & VASCULATURE 2021; 32:100723. [PMID: 33553570 PMCID: PMC7851334 DOI: 10.1016/j.ijcha.2021.100723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/10/2021] [Accepted: 01/14/2021] [Indexed: 10/26/2022]
Abstract
Background Clinically recognized coronary anomalies in adults are infrequent and characteristically establish on autopsy. The clinical importance coronary arteries consist of those with anomalous origin of the coronary artery from the opposite sinus of Valsalva (ACAOS) with an inter-arterial course (IAC). We have endeavored to attribute variable risk based on morphological appearances of the ACAOS by dual-source coronary computed tomography angiography (DSCTA). Material and methods ACAOS patients who undergoing DSCTA over a 5-year period were identified and assess morphologic characteristics. Medical records were reviewed for major adverse cardiovascular events (MACEs). Results A total of 1126 patients who undergoing DSCTA were evaluated. Twenty-four patients with ACAOS with IAC were recognized with a prevalence of 2.1% of study population. Twenty patients had anomalous origin of right coronary artery from left sinus of Valsalva (RCA-LSV) and 4 patients had anomalous origin of left coronary from right sinus of Valsalva (LCA-RSV). A significant increased prevalence of MACEs in were observed in intramural, slit-like and high inter-arterial course morphology group. Median follow-up time was 13 months (IQR 3-18 months). During follow-up 2 died, 4 had PCI, 13 had myocardial infarction and 7 had surgical treatment. Conclusions Intramural, slit-like and high type inter-arterial course morphology of ACAOS with IAC are high risk features for MACEs which can be identified by DSCTA.
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Affiliation(s)
| | - Pattarapong Makarawate
- Cardiology Unit, Internal Medicine Department, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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El Merhi F, Bou-Fakhredin R, El Ashkar B, Ghieh D, Ghosn Y, Saade C. State of the art of coronary computed tomography angiography. Radiography (Lond) 2020; 26:174-182. [PMID: 32052781 DOI: 10.1016/j.radi.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/21/2019] [Accepted: 10/02/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVES The aim of this paper is to evaluate contrast media (CM) bolus geometry and opacification patterns in the coronary arteries with particular focus on patient, scanner and safety considerations during coronary computed tomography angiography (CCTA). KEY FINDINGS The rapid evolution of computed tomography (CT) technology has seen this imaging modality challenge conventional coronary angiography in the evaluation of coronary artery disease. Increases in spatial and temporal resolutions have enabled CCTA to become the modality of choice when evaluating the coronary vascular tree as an alternative in the diagnostic algorithm for acute chest pain. However, these new technologic improvements in scanner technology have imposed new challenges for the optimisation of CM delivery and image acquisition strategies. CONCLUSION Understanding basic CM-imaging principles is essential for designing optimal injection protocols according to each specific clinical scenario, independently of scanner technology. IMPLICATIONS FOR PRACTICE With rapid advances in CT scanner technology including faster scan acquisitions, the risk of poor opacification of coronary vasculature increases significantly. Therefore, awareness of CM delivery protocols is paramount to consistently provide optimal image quality at a low radiation dose.
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Affiliation(s)
- F El Merhi
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O. Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - R Bou-Fakhredin
- American University of Beirut, P.O. Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - B El Ashkar
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O. Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - D Ghieh
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O. Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - Y Ghosn
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O. Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
| | - C Saade
- Diagnostic Radiology Department, American University of Beirut Medical Center, P.O. Box: 11-0236 Riad El-Solh, Beirut, 1107 2020, Lebanon.
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Zhao L, Bao J, Guo Y, Li J, Yang X, Lv T, Hao F, Wang Z, Yang Z, Liu A. Ultra-low dose one-step CT angiography for coronary, carotid and cerebral arteries using 128-slice dual-source CT: A feasibility study. Exp Ther Med 2019; 17:4167-4175. [PMID: 30988794 PMCID: PMC6447913 DOI: 10.3892/etm.2019.7420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022] Open
Abstract
Atherosclerotic diseases are systemic and patient outcomes depend on comprehensive imaging evaluation. Computed tomography angiography (CTA) is a powerful tool used to assess atherosclerosis. However, the scanning protocol is designed for cardiovascular and cerebrovascular imaging, which require considerations into the radiation dose, contrast agent and image quality. The purpose of the present study was to evaluate ultra-low dose one-step CTA for coronary, carotid and cerebral arteries with a low concentration contrast agent. A total of 78 patients were enrolled and randomly divided into two groups: Group A (n=38) and B (n=40). High-pitch CTA for coronary, carotid and cerebral arteries with a tube voltage of 70 or 80 kVp and 40 ml contrast agent (270 mgI/ml) was performed by a 128-slice dual-source CT scanner for group A. Standard high-pitch CTA with a tube voltage of 100 kVp and 60 ml contrast agent (370 mgI/ml) was conducted for group B. The image quality, radiation dose and amount of contrast agent in group A were evaluated and compared with group B. The dose length product for groups A and B was 62.95±21.54 vs. 160.15±15.13 mGy cm, respectively (t=−23.157, P<0.001). The mean total iodine content was 10.8±0 mg for group A and 22.2±0 mg for group B. In total, 99.4% of the arterial segments could be assessed for the two groups (χ2=0.267, P=0.606). The results revealed that ultra-low dose one-step high-pitch CTA can provide assessable image quality, and minimize the radiation dose and contrast agent.
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Affiliation(s)
- Lei Zhao
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Jiaqi Bao
- Department of Cardiology, Inner Mongolia People's Hospital, Hohhot, Inner Mongolia 010020, P.R. China
| | - Youmin Guo
- Department of Radiology, The Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Jianbo Li
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Xiaoguang Yang
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Tiegang Lv
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Fen'E Hao
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Zefeng Wang
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Zhenxing Yang
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
| | - Aishi Liu
- Department of Radiology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia 010050, P.R. China
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Seppelt D, Kolb C, Kühn JP, Speiser U, Radosa CG, Hoberück S, Hoffmann RT, Platzek I. Comparison of sequential and high-pitch-spiral coronary CT-angiography: image quality and radiation exposure. Int J Cardiovasc Imaging 2019; 35:1379-1386. [PMID: 30850908 DOI: 10.1007/s10554-019-01568-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/21/2019] [Indexed: 12/28/2022]
Abstract
New protocols for coronary computed tomography angiography (CCTA) could lower the radiation dose for patients but influence the image quality. To compare image quality and radiation exposure in step-and-shoot CCTA and high-pitch spiral CCTA. Fifty-nine pairs of patients matched for weight, height, sex and heart rate were included in this study (74 m, 44 f, average age 60 years, age range 29-94 years). Step-and-shoot CCTA and high-pitch spiral CCTA was performed on a third generation dual-source CT in equally sized patient groups. The signal-to-noise ratio (SNR) in the ascending aorta and the coronary arteries were determined for each dataset. Image quality was rated using a five-point scale. We used the t-test for paired samples to compare SNR and effective dose, and the Wilcoxon test to compare image quality scores. Mean effective dose for the step-and-shoot protocol (4.15 ± 3.07 mSv) was significantly higher in comparison to the high-pitch spiral protocol (1.2 ± 0.69 mSv; p < 0.0001). Mean SNR was higher with the step-and-shoot protocol compared to the high-pitch spiral protocol in the aorta, in the left main and peripheral coronary arteries (p < 0.01), in the proximal right coronary artery (p = 0.027). Image quality scores were significantly better for the step-and-shoot protocol (p = 0.0003). Step-and-shoot CCTA has significantly better SNR and overall image quality compared to high-pitch spiral CCTA, but with a mean effective dose more than thrice as high.
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Affiliation(s)
- D Seppelt
- Institute and Policlinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Carl-Gustav-Carus University, Fetscherstraße 74, 01307, Dresden, Germany.
| | - C Kolb
- Institute and Policlinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Carl-Gustav-Carus University, Fetscherstraße 74, 01307, Dresden, Germany
| | - J P Kühn
- Institute and Policlinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Carl-Gustav-Carus University, Fetscherstraße 74, 01307, Dresden, Germany
| | - U Speiser
- Department of Cardiology, Heart Centre Dresden University Hospital, Fetscherstraße 76, 01307, Dresden, Germany
| | - C G Radosa
- Institute and Policlinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Carl-Gustav-Carus University, Fetscherstraße 74, 01307, Dresden, Germany
| | - S Hoberück
- Department of Nuclear Medicine, Dresden University Hospital, Fetscherstraße 74, 01307, Dresden, Germany
| | - R T Hoffmann
- Institute and Policlinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Carl-Gustav-Carus University, Fetscherstraße 74, 01307, Dresden, Germany
| | - I Platzek
- Institute and Policlinic for Diagnostic and Interventional Radiology, Dresden University Hospital, Carl-Gustav-Carus University, Fetscherstraße 74, 01307, Dresden, Germany
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Rashed M, Banka P, Barthur A, MacDougal RD, Rathod RH, Powell AJ, Prakash A. Effects of Dose Reduction on Diagnostic Image Quality of Coronary Computed Tomography Angiography in Children Using a Third-Generation Dual-Source Computed Tomography Scanner. Am J Cardiol 2018; 122:1260-1264. [PMID: 30075893 DOI: 10.1016/j.amjcard.2018.06.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/11/2018] [Accepted: 06/15/2018] [Indexed: 11/26/2022]
Abstract
Performing coronary computed tomography angiography (CCTA) using third-generation dual source computed tomography (3G-DSCT) scanners results in radiation dose reduction without sacrificing image quality in adults. The largest dose reductions have been reported with prospectively gated, high-pitch imaging. However, there are limited data to determine if these benefits extend to pediatric patients. We evaluated image quality and radiation dose range of CCTA performed in children using a 3G-DSCT scanner. A retrospective review of 44 children (median age 10years, range 0.6 to 17) who underwent imaging to evaluate coronary artery origins (n = 27), Kawasaki disease (n = 12) or other coronary abnormalities (n = 5) were performed. General anesthesia was used in 9/44 (20%) patients and a β blocker was administered in 19/44 (43%). Prospectively gated high-pitch scanning was most frequently used (n = 24). Other techniques used included prospectively-gated "step and shoot" (n = 14), retrospectively gated (n = 2) and nongated high-pitch scan (n = 4). Median effective radiation doses were lowest for prospectively gated high-pitch scans (0.5mSv, range 0.4 to 0.7). Overall coronary artery image quality grade (1-excellent and 4-nondiagnostic) was acceptable for all electrocardiography-gated techniques, with no significant differences between high-pitch and "step-and-shoot" scan types (median 1, range 1 to 3 vs median 1, range 1 to 4, p = 0.22). Image quality grade was diagnostic (1 to 3) for all proximal coronary segments but rare distal segments were nondiagnostic (0.8% segments for gated high-pitch scan). In conclusion, CCTA can be performed in children using 3G-DSCT scanners withacceptable image quality. Prospectively gated high-pitch scans deliver the lowest radiation dose without reduction in image quality compared with conventional scan techniques.
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Affiliation(s)
- Moustafa Rashed
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Puja Banka
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ashita Barthur
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert D MacDougal
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Rahul H Rathod
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Ashwin Prakash
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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7
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Anatomical variants and coronary anomalies detected by dual-source coronary computed tomography angiography in North-eastern Thailand. Pol J Radiol 2018; 83:e372-e378. [PMID: 30655913 PMCID: PMC6334062 DOI: 10.5114/pjr.2018.78420] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 12/18/2022] Open
Abstract
Purpose Congenital coronary anomalies are uncommon, with an incidence ranging from 0.17% in autopsy cases to 1.2% in angiographically evaluated cases. The recent development of dual-source coronary computed tomography angiography (coronary CTA) allows accurate and noninvasive depiction of coronary artery anomalies. Material and methods A retrospective study included a total of 924 patients who underwent coronary CTA because of known or suspected coronary artery disease. In each study, coronary artery anomalies (CAs) were investigated. Results A total of 924 patients (mean age 51.2 ± 12.8 years), who underwent dual-source coronary CTA, were studied. The overall prevalence of CAs in our study was 3.7%, with the following distribution: four single coronary artery, 14 anomalous origin from opposite sinus of Valsalva, three absent left main, four high take-off coronary artery, three anomalous left coronary artery from pulmonary artery, and eight coronary artery fistulas. Conclusions The present study supports the use of coronary CTA as a reliable noninvasive tool for defining anomalous coronary arteries in an appropriate clinical setting and provides detailed three-dimensional anatomic information that may be difficult to obtain with invasive coronary angiography.
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Fang W, Wang CH, Yu YF, Wang LH, Tang DH, Xu DB, Ding ZY, Gu WH. The feasibility of 1-stop examination of coronary CT angiography and abdominal enhanced CT. Medicine (Baltimore) 2018; 97:e11651. [PMID: 30095622 PMCID: PMC6133558 DOI: 10.1097/md.0000000000011651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to evaluate the feasibility of performing coronary computed tomography angiography (CCTA) and abdominal enhanced computed tomography (CT) with 1-time injection of the agent.CCTA images (right coronary artery, left anterior descending coronary artery, and left circumflex coronary artery) were collected from 20 patients who completed a 1-stop combined examination of CCTA and abdominal enhanced CT (group A), 20 patients who only underwent abdominal enhanced CT (group B1), and 20 patients who only underwent CCTA (group B2). These images were interpreted using the 5-point Likert scale system by 2 experienced radiologists, and abdominal images were observed for breathing artifact. CT value, signal-to-noise ratio (SNR), and CTDI were recorded and compare among the 3 groups.The difference in image quality of the coronary and total volume of the contrast agent between group A and group B1 was not statistical significant (P > .05). The CT value and SNR in group B1 (CCTA) (CT: 394.65 ± 59.23, SNR: 17.38 ± 4.13) increased, compare with Group A (CT: 360.35 ± 34.16, SNR: 13.76 ± 1.84, P = .03, .01), while CTDI was undifferentiated between group A (17.14 ± 6.20) and group B1 (18.38 ± 9.79) (P = .64). The difference in CT value and SNR at the arterial phase and CT value at the venous phase between group A (abdomen) and group B2 were statistically significant, the CTDI in group A (9.09 ± 1.05) increased, compared with group B2 (8.23 ± 1.33) (P = .03), and SNR at the venous phase in group B2 (12.50 ± 2.43) increased, compared with group A (10.89 ± 2.03) (P = .03).Revolution CT can capture full images and very rapidly switch to the scan mode, enabling a 1-stop axial CCTA and enhanced helical abdominal scan. The 1-stop combined scan resulted in a satisfactory image quality, which reduced the contrast agent dose and simplified the workflow.The 1-stop combined scan allows for the high success rate of the examination, reduces the number of examinations, and decreases the dose and risk of injection of the contrast agent. This would be helpful for patients to obtain diagnostic images in time.
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Stocker TJ, Deseive S, Chen M, Leipsic J, Hadamitzky M, Rubinshtein R, Grove EL, Fang XM, Lesser J, Maurovich-Horvat P, Marques H, Andreini D, Tabbalat R, Kang JW, Eckert J, Dickson P, Forsdahl SH, Lambrechtsen J, Cury RC, Hausleiter J. Rationale and design of the worldwide prospective multicenter registry on radiation dose estimates of cardiac CT angiography in daily practice in 2017 (PROTECTION VI). J Cardiovasc Comput Tomogr 2017; 12:81-85. [PMID: 29233632 DOI: 10.1016/j.jcct.2017.11.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/04/2017] [Accepted: 11/30/2017] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac computed tomography angiography (cardiac CTA) is an increasingly used versatile imaging method to evaluate coronary and cardiac morphology. Owing to improvements in technology, image quality has continuously improved over the last 10-20 years. At the same time, numerous non-randomized and randomized studies have been performed to reduce the associated radiation exposure. Currently, it is unclear if the advances in technology and knowledge about radiation reduction translated into reduced levels of cardiac CTA radiation dose in daily clinical practice as well as a wide utilization of dose-saving strategies. METHODS The PROTECTION VI study is a multicenter, prospective, worldwide registry designed to evaluate radiation dose exposure, utilization of dose-saving strategies and diagnostic image quality during cardiac CTA in current daily practice. Assessment of image quality will be addressed by the evaluation of diagnostic image quality at the local study site and the calculation of quantitative image quality parameters in an imaging core laboratory. Above 4000 patients will be enrolled from approximately 70 sites in Europe, North America, South America, Asia and Australia. The study will analyze median radiation dose levels, image quality, frequency of use and efficacy of algorithms for dose reduction, and patient and study-related predictors associated with radiation dose. CONCLUSIONS The PROTECTION VI study is designed to provide a reliable estimate of current radiation dose for cardiac CTA and to assess the potential for additional dose reductions.
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Affiliation(s)
- Thomas J Stocker
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany.
| | - Simon Deseive
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany
| | - Marcus Chen
- National Heart, Lung, and Blood Institute, Bethesda, United States
| | | | | | | | | | | | - John Lesser
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, United States
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Budapest, Hungary
| | - Hugo Marques
- UNICA (Cardiovascular Imaging Unit), Hospital da Luz, Lisbon, Portugal
| | | | | | | | - Joachim Eckert
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt, Germany
| | | | | | | | | | - Jörg Hausleiter
- Medizinische Klinik und Poliklinik I, Klinikum der Universität, Ludwig-Maximilians-Universität, Munich, Germany.
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Andreini D, Pontone G, Mushtaq S, Mancini ME, Conte E, Guglielmo M, Volpato V, Annoni A, Baggiano A, Formenti A, Ditali V, Perchinunno M, Fiorentini C, Bartorelli AL, Pepi M. Image quality and radiation dose of coronary CT angiography performed with whole-heart coverage CT scanner with intra-cycle motion correction algorithm in patients with atrial fibrillation. Eur Radiol 2017; 28:1383-1392. [DOI: 10.1007/s00330-017-5131-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 10/05/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
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11
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Han R, Sun K, Lu B, Zhao R, Li K, Yang X. Diagnostic accuracy of coronary CT angiography combined with dual-energy myocardial perfusion imaging for detection of myocardial infarction. Exp Ther Med 2017; 14:207-213. [PMID: 28672916 PMCID: PMC5488534 DOI: 10.3892/etm.2017.4485] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/10/2016] [Indexed: 12/19/2022] Open
Abstract
The aim of the present study was to evaluate the diagnostic accuracy of second generation dual-energy computed tomography (DECT) myocardial perfusion imaging for the detection of myocardial infarction (MI) in patients with suspected MI. In total, 56 patients underwent DECT. Among those, 40 patients had MI that was detected by catheter coronary angiography and cardiac troponin I elevation and evolution of acute MI detected by electrocardiogram changes. The diagnostic accuracy, including the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the detection of MI were evaluated, as well as the coronary image quality of coronary artery and radiation dose. The sensitivity, specificity, PPV and NPV for the detection of MI were 95.0, 97.0, 86.4 and 98.9%, respectively. Moreover, the image quality was rated excellent (score 1) in 90.2% (515/571), good (score 2) in 6.5% (37/571), adequate (score 3) in 1.9% (11/571) and non-diagnostic (score 4) in 1.4% (8/571) of the coronary segments. The effective radiation dose was on average 6.1±1.5 mSv (3.1–10.9 mSv). Therefore, combined DE iodine maps and coronary CT angiography using the DECT may provide a high diagnostic accuracy for detecting MI with lower radiation exposure in patients with suspected MI.
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Affiliation(s)
- Ruijuan Han
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Kai Sun
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P.R. China
| | - Bin Lu
- Department of Radiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P.R. China
| | - Ruiping Zhao
- Department of Cardiology, Baotou Central Hospital, Baotou, Inner Mongolia 014040, P.R. China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Xinchun Yang
- Department of Cardiology, Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Fordyce CB, Douglas PS. Outcomes-Based CV Imaging Research Endpoints and Trial Design. JACC Cardiovasc Imaging 2017; 10:253-263. [DOI: 10.1016/j.jcmg.2017.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 01/12/2023]
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Linsen PVM, Coenen A, Lubbers MM, Dijkshoorn ML, Ouhlous M, Nieman K. Computed Tomography Angiography with a 192-slice Dual-source Computed Tomography System: Improvements in Image Quality and Radiation Dose. J Clin Imaging Sci 2016; 6:44. [PMID: 27833784 PMCID: PMC5093882 DOI: 10.4103/2156-7514.192840] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 09/07/2016] [Indexed: 11/04/2022] Open
Abstract
PURPOSE This study aims to compare image quality, radiation dose, and the influence of the heart rate on image quality of high-pitch spiral coronary computed tomography angiography (CCTA) using 128-slice (second generation) dual-source CT (DSCT) and a 192-slice DSCT (third generation) scanner. MATERIALS AND METHODS Two consecutive cohorts of fifty patients underwent CCTA by high-pitch spiral scan mode using 128 or 192-slice DSCT. The 192-slice DSCT system has a more powerful roentgen tube (2 × 120 kW) that allows CCTA acquisition at lower tube voltages, wider longitudinal coverage for faster table speed (732 m/s), and the use of iterative reconstruction. Objective image quality was measured as the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR). Subjective image quality was evaluated using a Likert scale. RESULTS While the effective dose was lower with 192-slice DSCT (1.2 ± 0.5 vs. 0.6 ± 0.3 mSv; P < 0.001), the SNR (18.9 ± 4.3 vs. 11.0 ± 2.9; P < 0.001) and CNR (23.5 ± 4.8 vs. 14.3 ± 4.1; P < 0.001) were superior to 128-slice DSCT. Although patients scanned with 192-slice DSCT had a faster heart rate (59 ± 7 vs. 56 ± 6; P = 0.045), subjective image quality was scored higher (4.2 ± 0.8 vs. 3.0 ± 0.7; P < 0.001) compared to 128-slice DSCT. CONCLUSIONS High-pitch spiral CCTA by 192-slice DSCT provides better image quality, despite a higher average heart rate, at lower radiation doses compared to 128-slice DSCT.
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Affiliation(s)
- Philip V M Linsen
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Adriaan Coenen
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marisa M Lubbers
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Mohamed Ouhlous
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Koen Nieman
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Image Quality and Radiation Dose for Prospectively Triggered Coronary CT Angiography: 128-Slice Single-Source CT versus First-Generation 64-Slice Dual-Source CT. Sci Rep 2016; 6:34795. [PMID: 27752040 PMCID: PMC5067634 DOI: 10.1038/srep34795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/19/2016] [Indexed: 12/02/2022] Open
Abstract
This study sought to compare the image quality and radiation dose of coronary computed tomography angiography (CCTA) from prospectively triggered 128-slice CT (128-MSCT) versus dual-source 64-slice CT (DSCT). The study was approved by the Medical Ethics Committee at Tongji Medical College of Huazhong University of Science and Technology. Eighty consecutive patients with stable heart rates lower than 70 bpm were enrolled. Forty patients were scanned with 128-MSCT, and the other 40 patients were scanned with DSCT. Two radiologists independently assessed the image quality in segments (diameter >1 mm) according to a three-point scale (1: excellent; 2: moderate; 3: insufficient). The CCTA radiation dose was calculated. Eighty patients with 526 segments in the 128-MSCT group and 544 segments in the DSCT group were evaluated. The image quality 1, 2 and 3 scores were 91.6%, 6.9% and 1.5%, respectively, for the 128-MSCT group and 97.6%, 1.7% and 0.7%, respectively, for the DSCT group, and there was a statistically significant inter-group difference (P ≤ 0.001). The effective doses were 3.0 mSv in the 128-MSCT group and 4.5 mSv in the DSCT group (P ≤ 0.001). Compared with DSCT, CCTA with prospectively triggered 128-MSCT had adequate image quality and a 33.3% lower radiation dose.
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Noto D, Funama Y, Utsunomiya D, Oda S, Yuki H, Yamashita Y. Patient-specific tube-voltage selection at coronary CT angiography based on the combination of X-ray attenuation on scout views and body mass index: how can appropriate radiation dose be achieved? Acta Radiol 2015; 56:1171-9. [PMID: 25267922 DOI: 10.1177/0284185114549826] [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: 04/23/2014] [Accepted: 08/12/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Body weight, body mass index (BMI), and scout X-ray radiographic attenuation can be used to predict image noise on computed tomographic coronary angiography (CTCA) images. PURPOSE To use a formula to predict patient-specific image noise and then select an appropriate CTCA patient-specific tube voltage for better radiation control. MATERIAL AND METHODS Forty-eight patients who underwent CTCA imaging at 120 kVp were reviewed, and their patient information and scouting X-ray radiographic attenuations were recorded to identify the best correlations between patient data and image noise and to develop a predicted image noise formula. Subsequently, 54 patients subjected to scanning at 100 or 120 kVp, depending on the noise predicted by our formula, were prospectively studied. Two radiologists visually assessed the image quality of the right coronary artery (RCA), left anterior descending artery (LAD), and left circumflex artery (LCX) by consensus readings. RESULTS The predicted image noise = 0.939 BMI + 0.025 scouting attenuation + 20.16. The median value of the overall image noise was 30.55 HU at 120 kVp and 29.85 HU at 100 kVp. The mean visual evaluation scores at 100 and 120 kVp were 3.25 and 3.24 for the proximal RCA, 3.40 and 3.26 for the proximal LAD, and 3.30 and 3.15 for the proximal LCX, respectively. CONCLUSION The BMI and scouting X-ray radiographic attenuation can be combined to predict the CTCA image noise. Our prediction formula is useful for deciding when to switch from the 120- to the 100-kVp technique.
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Affiliation(s)
| | | | | | - Seitaro Oda
- Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Hideaki Yuki
- Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan
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Chaikriangkrai K, Choi SY, Nabi F, Chang SM. Important advances in technology and unique applications to cardiovascular computed tomography. Methodist Debakey Cardiovasc J 2015; 10:152-8. [PMID: 25574342 DOI: 10.14797/mdcj-10-3-152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
For the past decade, multidetector cardiac computed tomography and its main application, coronary computed tomography angiography, have been established as a noninvasive technique for anatomical assessment of coronary arteries. This new era of coronary artery evaluation by coronary computed tomography angiography has arisen from the rapid advancement in computed tomography technology, which has led to massive diagnostic and prognostic clinical studies in various patient populations. This article gives a brief overview of current multidetector cardiac computed tomography systems, developing cardiac computed tomography technologies in both hardware and software fields, innovative radiation exposure reduction measures, multidetector cardiac computed tomography functional studies, and their newer clinical applications beyond coronary computed tomography angiography.
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Affiliation(s)
| | - Su Yeon Choi
- Seoul National University Hospital, Seoul, South Korea
| | - Faisal Nabi
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Su Min Chang
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
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State-of-the-Art Updates on Cardiac Computed Tomographic Angiography for Assessing Coronary Artery Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:398. [PMID: 26092612 DOI: 10.1007/s11936-015-0398-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OPINION STATEMENT Cardiac computed tomographic angiography (CCTA) is a noninvasive imaging modality that is increasingly useful for the evaluation of coronary artery disease (CAD). Over the past decade, CCTA has consistently demonstrated an excellent sensitivity for the detection and exclusion of coronary atherosclerosis in patients with stable or acute chest pain symptoms. Large prospective registries have repeatedly demonstrated the prognostic significance of the presence, extent, or absence of CAD by CCTA. In response to initial concerns, technical advances have permitted a dramatic reduction in patient radiation exposure with preserved image quality. For many patients, the radiation dose of CCTA is less than half of that with conventional myocardial perfusion imaging while providing significantly more anatomic information. Furthermore, CCTA's excellent spatial resolution is increasingly being used for noninvasive assessment of coronary plaque, including the detection of higher-risk vulnerable plaque and association between plaque characteristics and ischemia. Finally, new promising techniques that incorporate physiology with anatomy, such as CT-based fractional flow reserve (FFR-CT) and CT perfusion (CTP), are allowing for the noninvasive hemodynamic assessment of coronary stenoses and improvements in the specificity of CCTA findings. Such advances augur a coming transition when CCTA will be a first-line test for the detection, exclusion, and even management of CAD in many patients.
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Evaluation of high-pitch dual-source CT angiography for evaluation of coronary and carotid-cerebrovascular arteries. Eur J Radiol 2015; 84:398-406. [DOI: 10.1016/j.ejrad.2014.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 10/07/2014] [Accepted: 11/11/2014] [Indexed: 11/18/2022]
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Zheng M, Wu Y, Wei M, Liu Y, Zhao H, Li J. Low-concentration contrast medium for 128-slice dual-source CT coronary angiography at a very low radiation dose using prospectively ECG-triggered high-pitch spiral acquisition. Acad Radiol 2015; 22:195-202. [PMID: 25457735 DOI: 10.1016/j.acra.2014.07.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 06/30/2014] [Accepted: 07/16/2014] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the impact of low-concentration contrast medium on vascular enhancement, image quality, and radiation dose of coronary computed tomography (CT) angiography (CCTA) by using prospectively electrocardiography (ECG)-triggered high-pitch spiral acquisition with low tube voltage in combination with iterative reconstruction. MATERIALS AND METHODS One hundred patients (body mass index ≤ 25 kg/m(2), heart rate ≤ 65 beats per minute) were prospectively randomized to two groups, with 50 patients each, which were differed by contrast medium. All patients underwent prospectively ECG-triggered high-pitch spiral acquisition CCTA (2 × 128 × 0.6 mm, 300 mAs). Group A patients received iopromide 370 (370 mg I/mL), were scanned using 100 kVp, and reconstructed with filtered back projection. Group B patients received Iodixanol 270 (270 mg I/mL), were scanned using low tube voltage of 80 kVp, and reconstructed with iterative reconstruction techniques (IRT). CT attenuation was measured in coronary artery and other anatomic regions. Image quality score, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and radiation dose were calculated and compared. RESULTS The iodixanol 270 group showed no significant difference in image quality score (1.61 ± 0.69 vs 1.57 ± 0.66; P > .05), CT attenuation (P > .05), noise (P > .05), SNR (47.89 ± 14.03 vs 44.37 ± 12.79; P > .05), and CNR (42.38 ± 12.67 vs 38.13 ± 11.38; P > .05) in comparison to the iopromide 370 group but at a significantly lower radiation dose (0.26 ± 0.05 vs 0.57 ± 0.10; P < .001), which reflects dose saving of 54.4%. CONCLUSIONS Combining IRT with high-pitch spiral acquisition mode and low-tube-voltage technique, a low-concentration contrast medium of 270 mg I/mL can still maintain the contrast enhancement in coronary arteries without impairing image quality and significantly lower the radiation dose.
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Zhang JL, Liu BL, Zhao YM, Liang HW, Wang GK, Wan Y, Huang YH, Shen BZ. Combining Coronary with Carotid and Cerebrovascular Angiography Using Prospective ECG Gating and Iterative Reconstruction with 256-slice CT. Echocardiography 2014; 32:1291-8. [PMID: 25371093 DOI: 10.1111/echo.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jin-Ling Zhang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Bai-Lu Liu
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Yan-Ming Zhao
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Hong-Wei Liang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Guo-Kun Wang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Yong Wan
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Ya-Hua Huang
- Department of CT; The Second Affiliated Hospital of Harbin Medical University; Harbin China
| | - Bao-Zhong Shen
- Department of Radiology; The Fourth Affiliated Hospital of Harbin Medical University; Key Laboratory of Molecular Imaging in College of Heilongjiang Province; Harbin China
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Agarwal S, Parashar A, Ellis SG, Heupler FA, Lau E, Tuzcu EM, Kapadia SR. Measures to Reduce Radiation in a Modern Cardiac Catheterization Laboratory. Circ Cardiovasc Interv 2014; 7:447-55. [DOI: 10.1161/circinterventions.114.001499] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Shikhar Agarwal
- From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH
| | - Akhil Parashar
- From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH
| | - Stephen G. Ellis
- From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH
| | - Frederick A. Heupler
- From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH
| | - Evan Lau
- From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH
| | - E. Murat Tuzcu
- From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH
| | - Samir R. Kapadia
- From the Section of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute (S.A., S.G.E., F.A.H., E.L., E.M.T., S.R.K.), and Department of Internal Medicine (A.P.), Cleveland Clinic, OH
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Ghadri JR, Kazakauskaite E, Braunschweig S, Burger IA, Frank M, Fiechter M, Gebhard C, Fuchs TA, Templin C, Gaemperli O, Lüscher TF, Schmied C, Kaufmann PA. Congenital coronary anomalies detected by coronary computed tomography compared to invasive coronary angiography. BMC Cardiovasc Disord 2014; 14:81. [PMID: 25004927 PMCID: PMC4118645 DOI: 10.1186/1471-2261-14-81] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 05/22/2014] [Indexed: 12/28/2022] Open
Abstract
Background As coronary computed tomography angiography (CCTA) has emerged as a non-invasive alternative for evaluation of coronary anatomy with a lower referral threshold than invasive coronary angiography (ICA), the prevalence of coronary anomalies in CCTA may more closely reflect the true prevalence in the general population. Morphological features of coronary anomalies can be evaluated more precisely by CCTA than by ICA, which might lead to a higher identification of congenital coronary anomalies in CCTA compared to ICA. To evaluate the incidence, clinical and morphological features of the anatomy of patients with coronary anomalies detected either by coronary computed tomography angiography (CCTA) with prospective ECG-triggering or invasive coronary angiography (ICA). Methods Consecutive patients underwent 64-slice CCTA (n = 1′759) with prospective ECG-triggering or ICA (n = 9′782) and coronary anatomy was evaluated for identification of coronary anomalies to predefined criteria (origin, course and termination) according to international recommendations. Results The prevalence of coronary anomalies was 7.9% (n = 138) in CCTA and 2.1% in ICA (n = 203; p < 0.01). The most commonly coronary anomaly detected by CCTA was myocardial bridging 42.8% (n = 59) vs. 21.2% (n = 43); p < 0.01, while with ICA an absent left main trunk was the most observed anomaly 36.0% (n = 73; p < 0.01). In 9.4% (n = 13) of identified coronary anomalies in CCTA 9.4% were potentially serious coronary anaomalies, defined as a course of the coronary artery between aorta and pulmonary artery were identified. Conclusion The prevalence of coronary anomalies is substantially higher with CCTA than ICA even after exclusion of patients with myocardial bridging which is more frequently found with CCTA. This suggests that the true prevalence of coronary anomalies in the general population may have been underestimated based on ICA.
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Affiliation(s)
- Jelena R Ghadri
- Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
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Coronary artery calcium quantification from contrast enhanced CT using gemstone spectral imaging and material decomposition. Int J Cardiovasc Imaging 2014; 30:1399-405. [DOI: 10.1007/s10554-014-0474-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 06/16/2014] [Indexed: 01/07/2023]
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Characterization of Pulmonary Vein Dimensions Using High-Definition 64-Slice Computed Tomography prior to Radiofrequency Catheter Ablation for Atrial Fibrillation. Cardiol Res Pract 2014; 2014:179632. [PMID: 25089213 PMCID: PMC4096392 DOI: 10.1155/2014/179632] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Accepted: 05/26/2014] [Indexed: 12/20/2022] Open
Abstract
Background. Contrast-enhanced computed tomography is commonly acquired before radiofrequency catheter ablation (RFCA) for atrial fibrillation (AFib) to guide the procedure. We analyzed pulmonary vein (PV) ostial diameter and volumes on a high-definition 64-slice CT (HDCT) scanner in patients with AFib prior to RFCA. Methods and Results. This retrospective study included 50 patients (mean age 60.2 ± 11.4 years, 30 males) undergoing cardiac HDCT scanning before RFCA for drug refractory AFib and 50 age-, BMI-, and sex-matched controls with normal sinus rhythm undergoing HDCT. PV ostial diameter and volume were measured and calculated using a semiautomatic calliper tool. Total ostial PV volume was significantly increased in patients with AFib as compared to controls (P < 0.005). Similarly, total ostial PV diameter was significantly increased in AFib compared to controls (P < 0.001). In AFib, the largest PV volume and diameters were measured in right superior PV (P < 0.05 versus controls). The difference in PV volume between patients and controls was most pronounced in right superior PVs (P = 0.015). Right middle PVs were found more often in patients with AFib (16/50; 32%) than in normal subjects (7/50; 14%). Conclusion. Enlargement of PV ostial area and enlargement of volume are frequent findings in patients with drug refractory AFib. These parameters may add to the risk stratification for AFib recurrence following RFCA.
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Fuchs TA, Stehli J, Dougoud S, Fiechter M, Sah BR, Buechel RR, Bull S, Gaemperli O, Kaufmann PA. Impact of a new motion-correction algorithm on image quality of low-dose coronary CT angiography in patients with insufficient heart rate control. Acad Radiol 2014; 21:312-7. [PMID: 24332603 DOI: 10.1016/j.acra.2013.10.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 10/25/2013] [Accepted: 10/27/2013] [Indexed: 11/30/2022]
Abstract
RATIONALE AND OBJECTIVES Prospective electrocardiogram (ECG) triggering allows coronary computed tomography angiography (CCTA) scanning with low radiation dose but requires heart rates below 63 beats/min. We assessed the impact of a novel vendor-specific motion-correction algorithm on image quality and interpretability of low-dose CCTA acquired despite insufficient heart rate control. MATERIALS AND METHODS In 40 patients undergoing CCTA for the assessment of known or suspected coronary artery disease who did not reach the target heart rate below 63 beats/min despite β-blockade before prospective low-dose scanning, the temporal acquisition window was increased (80 ms additional padding). The new algorithm detects and integrates vessel path and velocity from adjacent cardiac phases for motion correction. Two blinded observers assessed image quality on a 4-point Likert scale (1, nonevaluative; 2, reduced but evaluative; 3, good; and 4, excellent) and the fraction of interpretable segments (score 2 or more) using motion correction versus standard reconstruction. RESULTS Image reconstruction with motion correction resulted in an increased median coronary artery image quality score (excellent interobserver agreement, κ = 0.85) compared to standard reconstruction (3.4 vs. 3.0, P < .001). Consequently, motion-corrected reconstruction significantly improved the overall interpretability of coronary arteries (from 78% to 88%, P < .001). Estimated mean effective radiation dose was 2.3 ± 0.8 mSv. CONCLUSIONS A novel, vendor-specific, motion-corrected, reconstruction algorithm improves image quality and interpretability of prospectively ECG-triggered low-dose CCTA despite insufficient heart rate control.
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Affiliation(s)
- Tobias A Fuchs
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland
| | - Julia Stehli
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland
| | - Svetlana Dougoud
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland
| | - Michael Fiechter
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland
| | - Bert-Ram Sah
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland
| | - Ronny R Buechel
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland
| | - Sacha Bull
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland
| | - Oliver Gaemperli
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland
| | - Philipp A Kaufmann
- Department of Nuclear Medicine and Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091, Zurich, Switzerland.
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Fuchs TA, Stehli J, Fiechter M, Dougoud S, Sah BR, Gebhard C, Bull S, Gaemperli O, Kaufmann PA. First in vivo head-to-head comparison of high-definition versus standard-definition stent imaging with 64-slice computed tomography. Int J Cardiovasc Imaging 2013; 29:1409-16. [DOI: 10.1007/s10554-013-0225-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
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Image quality of low-dose CCTA in obese patients: impact of high-definition computed tomography and adaptive statistical iterative reconstruction. Int J Cardiovasc Imaging 2013; 29:1565-74. [PMID: 23624958 DOI: 10.1007/s10554-013-0228-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/19/2013] [Indexed: 10/26/2022]
Abstract
The accuracy of coronary computed tomography angiography (CCTA) in obese persons is compromised by increased image noise. We investigated CCTA image quality acquired on a high-definition 64-slice CT scanner using modern adaptive statistical iterative reconstruction (ASIR). Seventy overweight and obese patients (24 males; mean age 57 years, mean body mass index 33 kg/m(2)) were studied with clinically-indicated contrast enhanced CCTA. Thirty-five patients underwent a standard definition protocol with filtered backprojection reconstruction (SD-FBP) while 35 patients matched for gender, age, body mass index and coronary artery calcifications underwent a novel high definition protocol with ASIR (HD-ASIR). Segment by segment image quality was assessed using a four-point scale (1 = excellent, 2 = good, 3 = moderate, 4 = non-diagnostic) and revealed better scores for HD-ASIR compared to SD-FBP (1.5 ± 0.43 vs. 1.8 ± 0.48; p < 0.05). The smallest detectable vessel diameter was also improved, 1.0 ± 0.5 mm for HD-ASIR as compared to 1.4 ± 0.4 mm for SD-FBP (p < 0.001). Average vessel attenuation was higher for HD-ASIR (388.3 ± 109.6 versus 350.6 ± 90.3 Hounsfield Units, HU; p < 0.05), while image noise, signal-to-noise ratio and contrast-to noise ratio did not differ significantly between reconstruction protocols (p = NS). The estimated effective radiation doses were similar, 2.3 ± 0.1 and 2.5 ± 0.1 mSv (HD-ASIR vs. SD-ASIR respectively). Compared to a standard definition backprojection protocol (SD-FBP), a newer high definition scan protocol in combination with ASIR (HD-ASIR) incrementally improved image quality and visualization of distal coronary artery segments in overweight and obese individuals, without increasing image noise and radiation dose.
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Fuchs TA, Stehli J, Fiechter M, Dougoud S, Gebhard C, Ghadri JR, Husmann L, Gaemperli O, Kaufmann PA. First experience with monochromatic coronary computed tomography angiography from a 64-slice CT scanner with Gemstone Spectral Imaging (GSI). J Cardiovasc Comput Tomogr 2013; 7:25-31. [PMID: 23452997 DOI: 10.1016/j.jcct.2013.01.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 09/21/2012] [Accepted: 01/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND New technology combining dual-energy CT with the latest gemstone detectors for spectral imaging (GSI) can be used to synthesize monochromatic images that mimic images as if different monochromatic x-ray sources were used. OBJECTIVE The aim of the study was to evaluate the optimal combination of monochromatic image energy and adaptive statistical iterative reconstruction (ASiR) for monochromatic reconstruction of coronary CT angiography (CTA) images with the use of GSI. METHODS Twenty consecutive patients underwent coronary CTA on a GSI capable 64-slice CT scanner (Discovery CT 750 High Definition, GE Healthcare). In 7 sets of monochromatic images (60, 65, 70, 75, 80, 90, and 110 keV; each with increasing contributions of ASiR, ie, 0%, 20%, 40%, 60%, and 80%; n = 35 reconstructions per patient), signal-to-noise (aortic root) and contrast-to-noise (left main artery) ratios were assessed. Signal-to-noise ratio, contrast-to-noise ratio, and image quality (graded on a 5-point Likert scale) were assessed in all above monochromatic reconstructions and compared with the respective standard (conventional polychromatic) image. RESULTS Compared with conventional polychromatic images, reconstructions with 60 keV and 80% ASiR showed the highest improvement in contrast-to-noise (144%; P < 0.001) and signal-to-noise ratio (173%; P < 0.001). Image quality reached a plateau at 65-75 keV with 40%-60% ASiR blending, yielding a maximal image quality score improvement of 50% compared with conventional imaging (P < 0.001). CONCLUSION In coronary CTA with low radiation technique (mean radiation dose, 1.8 ± 0.7 mSv), GSI with monochromatic reconstructions (65-75 keV) and ASiR (40%-60%) offers significant noise reduction and image quality improvement.
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Affiliation(s)
- Tobias A Fuchs
- Department of Radiology, Cardiac Imaging, University Hospital Zurich, Ramistrasse 100, NUK C 42, CH-8091 Zurich, Switzerland
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Bruining N. The diabetes conundrum: despite increasing incidences of coronary disease in diabetic type II patients, their first cathlab presentation is later than expected: observations from an angiographic and optical coherence tomography study. Eur Heart J 2012; 34:715-8. [PMID: 23264585 DOI: 10.1093/eurheartj/ehs441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
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Weijs B, Pisters R, Haest RJ, Kragten JA, Joosen IA, Versteylen M, Timmermans CC, Pison L, Blaauw Y, Hofstra L, Nieuwlaat R, Wildberger J, Crijns HJ. Patients originally diagnosed with idiopathic atrial fibrillation more often suffer from insidious coronary artery disease compared to healthy sinus rhythm controls. Heart Rhythm 2012; 9:1923-9. [DOI: 10.1016/j.hrthm.2012.08.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Indexed: 12/16/2022]
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Nakaura T, Kidoh M, Sakaino N, Utsunomiya D, Oda S, Kawahara T, Harada K, Yamashita Y. Low contrast- and low radiation dose protocol for cardiac CT of thin adults at 256-row CT: usefulness of low tube voltage scans and the hybrid iterative reconstruction algorithm. Int J Cardiovasc Imaging 2012; 29:913-23. [PMID: 23160977 DOI: 10.1007/s10554-012-0153-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 11/02/2012] [Indexed: 12/22/2022]
Abstract
To evaluate the effect on image quality of a low contrast and radiation dose protocol for cardiac computed tomography (CT) using a low tube voltage, the hybrid-iterative reconstruction algorithm, and a 256-row CT scanner. Before clinical study, we performed phantom experiments to evaluate the hybrid iterative reconstruction technique. We randomly assigned 68 patients undergoing cardiac CT to one of two protocols; 33 were scanned with our conventional 120 kVp protocol, the contrast material (370 mgI/kg body weight) was delivered over 15 s. The other 35 patients underwent scanning at a tube voltage of 80 kVp; the contrast dose, reduced by 50 % (185 mgI/kg), was delivered at the same fractional dose (24.7 mgI/kg/s). The 80 kVp images were post-processed with the 60 % hybrid-iterative reconstruction technique. We evaluated the effective dose (ED), image noise, mean attenuation, and contrast-to-noise ratio (CNR) of each protocol. The hybrid-iterative reconstruction technique offers almost same spatial resolution and noise-power-spectrum curve as compared with filtered back projection reconstruction. There were no decrease in spatial resolution and no shift of spatial frequency in noise power spectrum. The average ED was 74 % lower with the 80- than the 120 kVp protocol (1.4 vs 5.4 mSv). Dunnett's test showed that there were no significant differences in the image noise, mean attenuation, and CNR between hybrid-iterative-reconstructed 80 kVp scans and 120 kVp scans (28.6 ± 6.5 vs 25.3 ± 4.5, p = 0.18; 475.0 HU ± 87.0 vs 445.3 HU ± 67.7, p = 0.20; 17.1 HU ± 3.5 vs 17.8 HU ± 3.1, p = 0.53). The low kVp scan and hybrid-iterative reconstruction algorithm can dramatically decrease the radiation dose and contrast dose with adequate image quality at cardiac CT of thin adults using a 256-row CT scanner.
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Affiliation(s)
- Takeshi Nakaura
- Diagnostic Radiology, Amakusa Medical Center, kameba 854-1, Amakusa, Kumamoto 863-0046, Japan.
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Li JL, Huang MP, Liang CH, Zhao ZJ, Liu H, Cui YH, Liu QS, Zhang JE, Yang L, Ivanc TB, Yanof JH. Individualized radiation dose control in 256-slice CT coronary angiography (CTCA) in retrospective ECG-triggered helical scans: Using a measure of body size to adjust tube current selection. Eur J Radiol 2012; 81:3146-53. [DOI: 10.1016/j.ejrad.2012.04.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Revised: 04/20/2012] [Accepted: 04/21/2012] [Indexed: 12/01/2022]
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CT coronary angiography: impact of adapted statistical iterative reconstruction (ASIR) on coronary stenosis and plaque composition analysis. Int J Cardiovasc Imaging 2012; 29:719-24. [PMID: 23053859 DOI: 10.1007/s10554-012-0134-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 09/24/2012] [Indexed: 12/16/2022]
Abstract
To assess the impact of adaptive statistical iterative reconstruction (ASIR) on coronary plaque volume and composition analysis as well as on stenosis quantification in high definition coronary computed tomography angiography (CCTA). We included 50 plaques in 29 consecutive patients who were referred for the assessment of known or suspected coronary artery disease (CAD) with contrast-enhanced CCTA on a 64-slice high definition CT scanner (Discovery HD 750, GE Healthcare). CCTA scans were reconstructed with standard filtered back projection (FBP) with no ASIR (0 %) or with increasing contributions of ASIR, i.e. 20, 40, 60, 80 and 100 % (no FBP). Plaque analysis (volume, components and stenosis degree) was performed using a previously validated automated software. Mean values for minimal diameter and minimal area as well as degree of stenosis did not change significantly using different ASIR reconstructions. There was virtually no impact of reconstruction algorithms on mean plaque volume or plaque composition (e.g. soft, intermediate and calcified component). However, with increasing ASIR contribution, the percentage of plaque volume component between 401 and 500 HU decreased significantly (p < 0.05). Modern image reconstruction algorithms such as ASIR, which has been developed for noise reduction in latest high resolution CCTA scans, can be used reliably without interfering with the plaque analysis and stenosis severity assessment.
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Coronary artery calcium scoring: Influence of adaptive statistical iterative reconstruction using 64-MDCT. Int J Cardiol 2012; 167:2932-7. [PMID: 22959869 DOI: 10.1016/j.ijcard.2012.08.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 07/23/2012] [Accepted: 08/14/2012] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Assessment of coronary artery calcification is increasingly used for cardiovascular risk stratification. We evaluated the reliability of calcium-scoring results using a novel iterative reconstruction algorithm (ASIR) on a high-definition 64-slice CT scanner, as such data is lacking. METHODS AND RESULTS In 50 consecutive patients Agatston scores, calcium mass and volume score were assessed. Comparisons were performed between groups using filtered back projection (FBP) and 20-100% ASIR algorithms. Calcium score was measured in the coronary arteries, signal and noise were measured in the aortic root and left ventricle. In comparison with FBP, use of 20%, 40%, 60%, 80%, and 100% ASIR resulted in reduced image noise between groups (7.7%, 18.8%, 27.9%, 39.86%, and 48.56%, respectively; p<0.001) without difference in signal (p=0.60). With ASIR algorithms Agatston coronary calcium scoring significantly decreased compared with FBP algorithms (837.3 ± 130.3; 802.2 ± 124.9, 771.5 ± 120.7; 744.7 ± 116.8, 724.5 ± 114.2, and 709.2 ± 112.3 for 0%, 20%, 40%, 60%, 80%, and 100% ASIR, respectively, p<0.001). Volumetric score decreased in a similar manner (p<0.001) while calcium mass remained unchanged. Mean effective radiation dose was 0.81 ± 0.08 mSv. CONCLUSION ASIR results in image noise reduction. However, ASIR image reconstruction techniques for HDCT scans decrease Agatston coronary calcium scores. Thus, one needs to be aware of significant changes of the scoring results caused by different reconstruction methods.
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Paul JF, Amato A, Rohnean A. Low-dose coronary-CT angiography using step and shoot at any heart rate: comparison of image quality at systole for high heart rate and diastole for low heart rate with a 128-slice dual-source machine. Int J Cardiovasc Imaging 2012; 29:651-7. [PMID: 22918571 DOI: 10.1007/s10554-012-0110-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Accepted: 07/30/2012] [Indexed: 01/03/2023]
Abstract
To compare image quality of coronary CT angiography in step-and-shoot mode at the diastolic phase at low heart rates (<70 bpm) and systolic phase at high heart rates (≥70 bpm). We prospectively included 96 consecutive patients then excluded 5 patients with arrhythmia. Coronary CT-angiography was performed using a dual-source 128-slice CT machine, at the diastolic phase in the 55 patients with heart rates <70 bpm (group D) and at the systolic phase in the 36 patients with heart rates ≥70 (group S). Image quality was scored on a 5 point-scale (1, not interpretable; 2, insufficient for diagnosis; 3, fair, sufficient for diagnosis; 4, good; 5, excellent). In addition, we compared the number of stair-step artifacts in the two groups. Mean image quality score was 4 (0.78) in group D and 4.1 (0.34) in group S (NS), with an unequal distribution (p = 0.01). Step artifacts were seen in 44 % of group D and 18 % of group S patients (p = 0.02). In 3 group D patients and no group S patients, the image score was <3 due to artifacts, requiring repeat CT-angiography. When performing dual-source 128-slice CT-angiography, step-and-shoot acquisition provides comparable mean image quality in systole, with less variability and fewer stair-step artifacts, compared to diastole. This method may be feasible at any heart rate in most patients in sinus rhythm, allowing low-dose prospective acquisition without beta-blocker premedication.
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Affiliation(s)
- Jean-François Paul
- Department of Radiology, Centre Chirurgical Marie Lannelongue, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France.
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High-pitch computed tomography coronary angiography-a new dose-saving algorithm: estimation of radiation exposure. Radiol Res Pract 2012; 2012:724129. [PMID: 22701793 PMCID: PMC3371345 DOI: 10.1155/2012/724129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/04/2012] [Indexed: 11/27/2022] Open
Abstract
Purpose. To estimate effective dose and organ equivalent doses of prospective ECG-triggered high-pitch CTCA. Materials and Methods. For dose measurements, an Alderson-Rando phantom equipped with thermoluminescent dosimeters was used. The effective dose was calculated according to ICRP 103. Exposure was performed on a second-generation dual-source scanner (SOMATOM Definition Flash, Siemens Medical Solutions, Germany). The following scan parameters were used: 320 mAs per rotation, 100 and 120 kV, pitch 3.4 for prospectively ECG-triggered high-pitch CTCA, scan range of 13.5 cm, collimation 64 × 2 × 0.6 mm with z-flying focal spot, gantry rotation time 280 ms, and simulated heart rate of 60 beats per minute. Results. Depending on the applied tube potential, the effective whole-body dose of the cardiac scan ranged from 1.1 mSv to 1.6 mSv and from 1.2 to 1.8 mSv for males and females, respectively. The radiosensitive breast tissue in the range of the primary beam caused an increased female-specific effective dose of 8.6%±0.3% compared to males. Decreasing the tube potential, a significant reduction of the effective dose of 35.8% and 36.0% can be achieved for males and females, respectively (P < 0.001). Conclusion. The radiologist and the CT technician should be aware of this new dose-saving strategy to keep the radiation exposure as low as reasonablly achievable.
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Picano E, Vano E. The radiation issue in cardiology: the time for action is now. Cardiovasc Ultrasound 2011; 9:35. [PMID: 22104562 PMCID: PMC3256101 DOI: 10.1186/1476-7120-9-35] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 11/21/2011] [Indexed: 02/07/2023] Open
Abstract
The "radiation issue" is the need to consider possible deterministic effects (e.g., skin injuries) and long-term cancer risks due to ionizing radiation in the risk-benefit assessment of diagnostic or therapeutic testing. Although there are currently no data showing that high-dose medical studies have actually increased the incidence of cancer, the "linear-no threshold" model in radioprotection assumes that no safe dose exists; all doses add up in determining cancer risks; and the risk increases linearly with increasing radiation dose. The possibility of deterministic effects should also be considered when skin or lens doses may be over the threshold. Cardiologists have a special mission to avoid unjustified or non-optimized use of radiation, since they are responsible for 45% of the entire cumulative effective dose of 3.0 mSv (similar to the radiological risk of 150 chest x-rays) per head per year to the US population from all medical sources except radiotherapy. In addition, interventional cardiologists have an exposure per head per year two to three times higher than that of radiologists. The most active and experienced interventional cardiologists in high volume cath labs have an annual exposure equivalent to around 5 mSv per head and a professional lifetime attributable to excess cancer risk on the order of magnitude of 1 in 100. Cardiologists are the contemporary radiologists but sometimes imperfectly aware of the radiological dose of the examination they prescribe or practice, which can range from the equivalent of 1-60 mSv around a reference dose average of 10-15 mSv for a percutaneous coronary intervention, a cardiac radiofrequency ablation, a multi-detector coronary angiography, or a myocardial perfusion imaging scintigraphy. A good cardiologist cannot be afraid of life-saving radiation, but must be afraid of radiation unawareness and negligence.
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Affiliation(s)
| | - Eliseo Vano
- Institute of Clinical Physiology, CNR, Pisa, Italy
- San Carlos University Hospital, Complutense University of Madrid, Madrid, Spain
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