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Richards CE, Obaid DR. Low-Dose Radiation Advances in Coronary Computed Tomography Angiography in the Diagnosis of Coronary Artery Disease. Curr Cardiol Rev 2019; 15:304-315. [PMID: 30806322 PMCID: PMC8142354 DOI: 10.2174/1573403x15666190222163737] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 01/16/2023] Open
Abstract
Background
Coronary computed tomography angiography (CCTA) is now widely used in the diagnosis of coronary artery disease since it is a rapid, minimally invasive test with a diagnostic accuracy comparable to coronary angiography. However, to meet demands for increasing spatial and temporal resolution, higher x-ray radiation doses are required to circumvent the resulting increase in image noise. Exposure to high doses of ionizing radiation with CT imaging is a major health concern due to the potential risk of radiation-associated malignancy. Given its increasing use, a number of dose saving algorithms have been implemented to CCTA to minimize radiation exposure to “as low as reasonably achievable (ALARA)” without compromising diagnostic image quality. Objective
The purpose of this review is to outline the most recent advances and current status of dose saving techniques in CCTA. Method
PubMed, Medline, EMBASE and Scholar databases were searched to identify feasibility studies, clinical trials, and technology guidelines on the technical advances in CT scanner hardware and reconstruction software. Results
Sub-millisievert (mSv) radiation doses have been reported for CCTA due to a combination of strategies such as prospective electrocardiogram-gating, high-pitch helical acquisition, tube current modulation, tube voltage reduction, heart rate reduction, and the most recent novel adaptive iterative reconstruction algorithms. Conclusion
Advances in radiation dose reduction without loss of image quality justify the use of CCTA as a non-invasive alternative to coronary catheterization in the diagnosis of coronary artery disease.
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Affiliation(s)
- Caryl E Richards
- Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, United Kingdom
| | - Daniel R Obaid
- Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, United Kingdom.,Swansea University Medical School, Swansea University, Grove Building, Singleton Park, Sketty, Swansea SA2 8PP, United Kingdom
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Cappabianca S, Belfiore MP, Reginelli A, Capasso R, Del Prete A, Petrillo M, Mascia P, Rossi C, Romano F, De Filippo M, Scialpi M, Gragnano F, Calabrò P, Belfiore G, Brunese L, Grassi R, Rotondo A. Mandatory Reporting of Coronary Artery Calcifications Incidentally Noted on Chest Multi-Detector Computed Tomography: A Multicentre Experience. Curr Vasc Pharmacol 2018; 17:92-98. [PMID: 29345585 DOI: 10.2174/1570161116666180117111856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Coronary Artery Calcifications (CACs) are associated with coronary atherosclerosis and Cardiovascular (CV) events. In "non-cardiovascular" settings, CACs can be easily detected on chest Multi-Detector Computed Tomography (MDCT). Their evaluation may help to better stratify CV risk in the general population, especially for primary prevention. AIMS We retrospectively evaluated the relationship between CAC distribution and CV risk, determined by Framingham Risk Score (FRS), in a cohort of patients who underwent chest MDCT performed for several clinical indications. METHOD We retrospectively recruited 305 patients (194 men, 111 women; mean age 70.5 years) from 3 different Italian centres. Patients with coronary stent, pacemaker and/or CV devices were excluded from the study. Circumflex Artery (LCX), Left Main Coronary Artery (LMCA), left Anterior Descending artery (LAD) and right coronary artery (RCA) were analysed. RESULTS From a total population of 305 patients, 119 (39%) had low FRS (<10%), 115 (38%) had intermediate FRS (10-20%), and 71 (23%) had high FRS (>20%). The study identified 842 CACs located in decreasing order as follows: RCA (34.5%), LAD (32.3%), LCX (28%) and LMCA (13%). Statistical two-step analysis subdivided patients into two clusters according to FRS (risk threshold = 12.38%): cluster I (mean 9.34) and cluster II (mean 15.09). A significant association between CAC distribution and cluster II was demonstrated. CACs were mostly detected in patients with intermediate FRS. All patients (100%) with the highest CV risk showed intermediate RCA and LMCA involvement. CONCLUSION Radiologists can note the distribution of CACs on a chest MDCT and should mandatorily record them in their reports. Depending on CAC presence and location, these findings may have important clinical implications, mostly in asymptomatic patients with intermediate FRS. This information may reclassify a patients' CV risk and improve clinical management.
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Affiliation(s)
- Salvatore Cappabianca
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Maria Paola Belfiore
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Alfonso Reginelli
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Raffaella Capasso
- Department of Medicine and Health Sciences, University of Molise, 86100, Campobasso, Italy
| | - Alessandra Del Prete
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Mario Petrillo
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Paola Mascia
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Claudia Rossi
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Francesco Romano
- Department of Mental and Physical Health and University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Massimo De Filippo
- Department of Clinical Sciences, Section of Radiological Sciences, University Hospital of Parma, 43100, Parma, Italy
| | - Michele Scialpi
- Department of Surgical, Radiological and Odontostomatological Sciences, Division of Radiology 2, Perugia University, S. Maria della Misericordia Hospital, 06134, Perugia, Italy
| | - Felice Gragnano
- Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Calabrò
- Department of Cardiothoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Belfiore
- Department of Diagnostic Imaging, "Sant'Anna and San Sebastiano" Hospital, 81100, Caserta, Italy
| | - Luca Brunese
- Department of Medicine and Health Sciences, University of Molise, 86100, Campobasso, Italy
| | - Roberto Grassi
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
| | - Antonio Rotondo
- Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", 80131, Naples, Italy
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Zhao C, Jiang M, Liu J, Gao L, Wang X. Feasibility of low-dose coronary computed tomographic angiography used in atrial fibrillation patients. Acta Cardiol 2017. [PMID: 28636511 DOI: 10.1080/00015385.2017.1304739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The diagnosis of coronary artery disease (CAD) in atrial fibrillation (AF) patients using coronary computed tomography angiography (CCTA) requires a large exposure dosage or repeated examinations. This study evaluates the feasibility of using low-dose CCTA in the double prospectively ECG-triggered high-pitch spiral acquisition mode (Double Flash Spiral mode). METHODS Twenty-eight AF patients with suspected CAD were recruited. Double Flash Spiral mode (tube voltage 100 kVp) and iterative reconstruction was used for CCTA examination. Two radiologists cross-evaluated the CCTA image quality. The effective radiation dose was measured for each patient. RESULTS Twenty-eight AF patients (10 female, 18 male, mean age 68.8 ± 13.9 y, body mass index 24.3 ± 2.3 kg/cm2) were recruited and 337 artery segments were evaluated. In total, 98.5% (332/337) of the coronary artery segments and 96.4% (27/28) of the AF patients were rated as diagnostically evaluable. Of these 27 diagnosable patients, 17 patients (63%) were diagnosed with multi-vessel stenosis. Besides, 5 of 28 patients (17.9%) have left atrial appendage thrombus. The quality of the integrated image was significantly better than either of the individual first or the second scans, based on segments (P < 0.001) and patients (P < 0.05). The mean effective radiation dose was 1.5 mSv ±0.4 mSv. CONCLUSIONS Using the Double Flash Spiral mode at low radiation dose (mean 1.5 mSv), 98.5% of the coronary segments and 96.4% of the scans were of sufficient diagnostic quality.
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Affiliation(s)
- Chenglin Zhao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Mengxi Jiang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Jianxin Liu
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Li Gao
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China
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