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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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Mousavi Gazafroudi SS, Tavakkoli MB, Moradi M, Mousavi Gazafroudi SS, Yadegarfar G, Behjati M, Karimian M, Sajjadieh Khajouei A. Coronary CT angiography by modifying tube voltage and contrast medium concentration: Evaluation of image quality and radiation dose. Echocardiography 2019; 36:1391-1396. [PMID: 31215700 DOI: 10.1111/echo.14410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/22/2019] [Accepted: 05/26/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Currently, there is an increasing interest in noninvasive imaging of cardiovascular system such as computed tomography coronary angiography (CCTA). The risks of radiation-induced cancer and contrast-induced nephropathy (CIN) have always been regarded as concerns which increased demand for CCTA using reduced radiation dose and iodine intake. We aimed to evaluate the image quality and radiation dose of CCTA by modifying tube voltage and concentration of contrast media. METHODS The present study includes 105 patients who underwent CCTA for clinical indications. Specific inclusion and exclusion criteria in terms of patient's weight, body mass index, calcium score, and stenting were used. First group of patients scanned by 120 kV and 370 mg I/mL contrast medium, compared with second and third groups for which scanning was performed using 100 kV and 370 mg I/mL and 100 kV and 300 mg I/mL, respectively. Image quality was evaluated both subjectively and objectively. The effective dose and iodine intake were also measured. RESULTS Using low kV protocols led to radiation dose reduction up to 38% and applying low contrast medium concentration with consequent reduced iodine intake up to 21%. Moreover, there were significant differences in image quality of new scanning protocols. CONCLUSION Reduction in tube voltage with lowering of contrast medium concentration can reduce radiation dose and iodine intake with acceptable image quality.
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Affiliation(s)
| | | | - Maryam Moradi
- Radiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Ghasem Yadegarfar
- Epidemiology Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohaddeseh Behjati
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Karimian
- Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran
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Nazli SB, Aghamiri SMR, Gholizadeh Sendani N, Shams Akhtari A. EVALUATION OF RADIATION ABSORBED DOSE AND IMAGE QUALITY IN DIFFERENT RETROSPECTIVE-ECG GATING ACQUISITION METHODS OF CARDIAC CT ANGIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2018; 178:304-309. [PMID: 28981808 DOI: 10.1093/rpd/ncx111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
Cardiac computed tomography angiography (CCTA) studies have risen concern of radiobiological effects over the patients. Therefore, estimating radiation doses absorbed during CCTA is important. In this study, we compared radiation dose and image quality by using three different retrospective electrocardiography (ECG) protocols. A total of 123 patients undergoing CCTA were divided in three different groups. We used full-dose modulation (CareDose4D) technique in group (1); fixed tube current 200 mAs for group (2); and in group (3), chest circumference was used to adapt tube current (180-200 mAs) and tube potential (100-120 kVp). For groups (1) and (2), tube potential adapted depends on body mass index (BMI) in which it was 100 kVp for BMI < 27 kg/m2, and 120 kVp for BMI ≥ 27 kg/m2. Quantitive assessment of image quality was calculated by measuring signal intensity (SI) and image noise (IN) in the proximal segments of aorta root on left and right coronary arteries. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were also calculated by using SI and IN. Two experienced radiologists using a 4-point scale assessed the subjective image quality. Our results show that in group (1), the mean effective dose was 4.46 mSv (range: 1.75-8.6 mSv) and for group (2), the mean effective radiation dose was 5.07 mSv (range: 2.57-9.74 mSv) and in group (3), the mean effective dose was 5.85 mSv (range: 3.36-12.17 mSv). Group (1) representing 12% and 23% decrease in radiation dose comparing by groups (2) and (3). In multivariate analysis, adjusting for BMI, radiation dose for patients with BMI < 27 kg/m2 was significantly different; 2.53 mSv for group (1) compared to 3.54 mSv in group (2) and 5.207 in group (3) (p < 0.0001). In addition, lowering tube potential from 120 to 100 kVp in 200 mAs fixed tube current, represents 27% decrease in radiation dose. The quantitative image quality (IN, SI, SNR and CNR) was not statistically significant among the groups. To sum up, Retrospective-ECG gating may reduce radiation dose by using automatic tube current modulation and 100kVp tube potential with preservation of image quality in patient's whose BMI < 27 kg/m2.
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Affiliation(s)
| | | | | | - Amin Shams Akhtari
- Department of Emergency Medicine, Faculty of Medical Science, Shahid Beheshti Medical University, Tehran, Iran
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A preliminary feasibility study of simultaneous dual-isotope imaging with a solid-state dedicated cardiac camera for evaluating myocardial perfusion and fatty acid metabolism. Heart Vessels 2014; 31:38-45. [DOI: 10.1007/s00380-014-0578-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/29/2014] [Indexed: 11/26/2022]
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Mlynarski R, Mlynarska A, Sosnowski M. Coronary venous system in cardiac computer tomography: Visualization, classification and role. World J Radiol 2014; 6:399-408. [PMID: 25071880 PMCID: PMC4109091 DOI: 10.4329/wjr.v6.i7.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 02/28/2014] [Accepted: 05/19/2014] [Indexed: 02/06/2023] Open
Abstract
The role of the coronary venous system was underestimated for many years. In the last 20 years, a few percutaneous cardiology techniques in which the anatomy of the coronary venous system was significant were developed and are in use. The most important seems to be cardiac resynchronization therapy, which is an invasive method for the treatment of heart failure. Unfortunately, one of the major problems is the significant anatomical variability of the coronary venous system. The description of the selected anatomical structures is only useful in selected cases such as, for example, the obstruction of selected vessels, a huge Thebesian valve, etc. The 3D images can add significant value; however, their usefulness is limited due to the different points of view that are obtained during intra-operational fluoroscopy. After summarizing all of the articles and guidelines, it can be recommended that the visualization of the coronary venous system be performed in certain patients before cardiac resynchronization. The best option is to use tomography with retrospective gating with the optimal reconstruction of cardiac veins that occurs during the diastolic phases.
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Tomizawa N, Maeda E, Akahane M, Torigoe R, Kiryu S, Ohtomo K. Coronary CT angiography using the second-generation 320-detector row CT: assessment of image quality and radiation dose in various heart rates compared with the first-generation scanner. Int J Cardiovasc Imaging 2013; 29:1613-8. [DOI: 10.1007/s10554-013-0238-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 05/13/2013] [Indexed: 01/10/2023]
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Radiation dose in cardiac imaging: how should it affect clinical decisions? AJR Am J Roentgenol 2013; 200:508-14. [PMID: 23436838 DOI: 10.2214/ajr.12.9773] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to discuss whether and how the risks of exposure to ionizing radiation should affect clinical decision making in patients with known or suspected cardiovascular disease. CONCLUSION Although the prevalence of cardiovascular disease and frequency of diagnostic testing has risen dramatically, cardiovascular mortality has declined. Earlier and more accurate detection of cardiovascular disease may play an important role. Concerns regarding excessive radiation exposure from cardiovascular imaging have been raised. Efforts to reduce exposure have included selection of appropriate patients for cardiovascular testing, technologic advances, educational resources, and a directed patient-centered approach to testing.
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Soloperto G, Casciaro S. Progress in atherosclerotic plaque imaging. World J Radiol 2012; 4:353-71. [PMID: 22937215 PMCID: PMC3430733 DOI: 10.4329/wjr.v4.i8.353] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/14/2012] [Accepted: 05/21/2012] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases are the primary cause of mortality in the industrialized world, and arterial obstruction, triggered by rupture-prone atherosclerotic plaques, lead to myocardial infarction and cerebral stroke. Vulnerable plaques do not necessarily occur with flow-limiting stenosis, thus conventional luminographic assessment of the pathology fails to identify unstable lesions. In this review we discuss the currently available imaging modalities used to investigate morphological features and biological characteristics of the atherosclerotic plaque. The different imaging modalities such as ultrasound, magnetic resonance imaging, computed tomography, nuclear imaging and their intravascular applications are illustrated, highlighting their specific diagnostic potential. Clinically available and upcoming methodologies are also reviewed along with the related challenges in their clinical translation, concerning the specific invasiveness, accuracy and cost-effectiveness of these methods.
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