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Yu H, Wang H, Gao Z, Chen G, Song H, Yan S, Luan X, Song P. A Heart Rate-Dependent Protocol of "One-Stop" Computed Tomography Angiography of Coronary Combined with Pulmonary Arteries Reduces the Dosages of Contrast Agent. Dose Response 2022; 20:15593258221107906. [PMID: 35783237 PMCID: PMC9247373 DOI: 10.1177/15593258221107906] [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: 02/24/2022] [Revised: 04/09/2022] [Accepted: 05/31/2022] [Indexed: 11/16/2022]
Abstract
Background: The personalized, heart rate-dependent computed tomography angiography (CTA)
protocol can reduce the use of contrast medium (CM) and the radiation dose.
This is especially beneficial for patients with CTA of coronary combined
with pulmonary arteries. Purpose: To evaluate the feasibility of low CM in one-stop coronary and pulmonary
arterial CTA tailored by patients’ heart rate. Material and Methods: 94 patients set to undergo CTA of coronary combined with pulmonary arteries
with one-stop scans. Patients were prospectively randomized into two groups:
For group A (n = 47), the timing of the scans was determined according to
the patient’s HR using 30 mL CM; For group B (n = 47), in which the routine
bolus tracking was applied by setting the ascending aortic threshold of 80
HU with 70 mL CM, scans were performed simultaneously. Results: Compared with group B, group A had slightly higher computed tomography (CT)
value and image quality of pulmonary artery (CT value: group A 484.7HU;
group B 457.9HU; t = 2.446, P = .016; image quality: χ2 =
8.292, P = .016), but in coronary artery wasn’t
statistically different between two groups(image quality: χ2 = 2.516,
P = .642). Conclusion: The heart rate-dependent CM injection protocol can greatly reduce the use of
CM, simplify the work-flow, and may obtain comparable or even better image
quality compared with the routine bolus tracking.
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Affiliation(s)
- Hairong Yu
- Department of Radiology, Central Hospital Affiliated to
Shandong First Medical University, Jinan City, China
| | - Hui Wang
- Department of Radiology, Central Hospital Affiliated to
Shandong First Medical University, Jinan City, China
| | - Zhen Gao
- Department of Radiology, Central Hospital Affiliated to
Shandong First Medical University, Jinan City, China
| | - Guoyue Chen
- Department of Radiology, Central Hospital Affiliated to
Shandong First Medical University, Jinan City, China
| | - Hao Song
- The Institute for Tissue
Engineering and Regenerative Medicine, The Liaocheng University/Liaocheng
People’s Hospital, Liaocheng, China
| | - Shihao Yan
- Department of Radiology, Central Hospital Affiliated to
Shandong First Medical University, Jinan City, China
| | | | - Peiji Song
- Department of Radiology, Central Hospital Affiliated to
Shandong First Medical University, Jinan City, China
- Department of Radiology, Jinan
Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan City, China
- Peiji Song, Department of Radiology, Jinan
Central Hospital, Cheeloo College of Medicine, Shandong University, No.105,
Jiefang Road, Jinan City 250013, China; Department of Radiology, Central
Hospital Affiliated to Shandong First Medical University, No.105, Jiefang Road,
Jinan City 250013, China.
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Coronary CT Angiography: Use in Patients With Chest Pain Presenting to Emergency Departments. AJR Am J Roentgenol 2018; 210:816-820. [PMID: 29446681 DOI: 10.2214/ajr.17.18740] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Previously published reports have shown that coronary CT angiography (CCTA) is a more efficient method of diagnosis than myocardial perfusion imaging (MPI) and stress echocardiography for patients presenting to emergency departments (EDs) with acute chest pain. In light of this evidence, the objective of this study was to examine recent trends in the use of these techniques in EDs. MATERIALS AND METHODS The nationwide Medicare Part B databases for 2006-2015 were the data source. The Current Procedural Terminology, version 4, codes for CCTA, MPI, and stress echocardiography were selected. Medicare place-of-service codes were used to determine procedure volumes in EDs. Medicare specialty codes were used to ascertain how many of these examinations were interpreted by radiologists, cardiologists, and other physicians as a group. RESULTS From 2006 to 2015, there was essentially no change in the number of MPI examinations performed in EDs for patients using Medicare (22,342 in 2006, 22,338 in 2015) or in the number of stress echocardiograms (3544 in 2006, 3520 in 2015). By contrast, the number of CCTA examinations increased rapidly, from 126 in 2006 to 1919 in 2015 (compound annual growth rate, 35%). Despite this rapid growth, patients in EDs underwent 11.6 times as many MPI as CCTA examinations in 2015. In that last year of the study, radiologists interpreted 78% of ED MPI and 83% of ED CCTA examinations. CONCLUSION Use of CCTA in EDs has increased rapidly, but far more MPI examinations are still being performed. This finding suggests that recently acquired evidence is not yet being fully acted upon.
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Healthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr 2017; 11:404-414. [DOI: 10.1016/j.jcct.2017.08.008] [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: 05/22/2017] [Revised: 08/14/2017] [Accepted: 08/14/2017] [Indexed: 12/14/2022]
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Murphy DJ, Keraliya A, Himes N, Aghayev A, Blankstein R, Steigner ML. Quantification of radiation dose reduction by reducing z-axis coverage in 320-detector coronary CT angiography. Br J Radiol 2017; 90:20170252. [PMID: 28613933 DOI: 10.1259/bjr.20170252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To quantify the radiation dose reduction achievable by minimizing z-axis coverage in 320-detector coronary CT angiography (CCTA). METHODS We retrospectively reviewed 130 CCTAs performed on 320-detector CT that offers up to 16 cm z-axis coverage (adjustable in 2-cm increments), allowing complete coverage of the heart in a single gantry rotation. For each CT, we obtained the radiation dose [CT dose index and dose-length product (DLP)], measured the z-axis field of view and measured the craniocaudal cardiac size (distance from the left main coronary artery to the cardiac apex). We calculated the radiation dose savings achievable by reducing the z-axis coverage to the minimum necessary to cover the heart using 320 × 0.5-mm (maximum 16 cm) and 256 × 0.5-mm (maximum 12.8 cm) detector collimations. RESULTS Results are expressed as mean ± standard deviation. The mean craniocaudal cardiac size was 10.5 ± 1.0 cm, with 85% (n = 112) of CCTAs performed with 16 cm of z-axis coverage. The mean DLP was 417.6 ± 182.4 mGy cm, with the mean DLP saving achievable using the minimum z-axis coverage required to completely image the heart being 96.2 ± 47.4 mGy cm, an average dose reduction of 26.9 ± 7.0%. z-axis coverage of ≤12 cm was adequate for 92% and 12.8 cm for 98% of subjects. CONCLUSION Using the minimal z-axis coverage to adequately image the heart is a simple step that can reduce the DLP in 320-detector CCTA by approximately 27%. z-axis coverage of ≤12 cm is adequate for 92%, 12.8 cm for 98% and 14 cm for 100% of patients undergoing CCTA. Advances in knowledge: Reducing z-axis coverage in 320-detector CCTA can reduce DLP by approximately 27%.
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Affiliation(s)
- David J Murphy
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Abhishek Keraliya
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nathan Himes
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Michael L Steigner
- Cardiovascular Imaging Program, Departments of Radiology and Medicine (Cardiovascular Division), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Aghayev A, Murphy DJ, Keraliya AR, Steigner ML. Recent developments in the use of computed tomography scanners in coronary artery imaging. Expert Rev Med Devices 2016; 13:545-53. [PMID: 27140944 DOI: 10.1080/17434440.2016.1184968] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Within the past decade, substantial evolution of Coronary CT Angiography (CCTA) has affected evaluation and management of coronary artery disease. In particular, technical advancement of hardware technology and image reconstruction of CT scanners have played an important role in this context making it possible to acquire abundant data with excellent temporal and spatial resolution within a shorter scan time. In addition, a concern related to the high radiation exposure in the initial noninvasive coronary artery imaging has triggered improvement in dose reduction techniques. AREAS COVERED In this review article, we have focused on recent technological developments in CT scanners and the impact of these developments on CCTA parameters. Expert Commentary: CCTA plays an important role in coronary artery disease management, and technical development of the CT scanners can be expected to address and remedy technical limitations.
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Affiliation(s)
- Ayaz Aghayev
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - David J Murphy
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - Abhishek R Keraliya
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
| | - Michael L Steigner
- a Department of Radiology , Brigham and Women's Hospital , Boston , MA , USA
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Hamilton-Craig C, Fifoot A, Hansen M, Pincus M, Chan J, Walters DL, Branch KR. Diagnostic performance and cost of CT angiography versus stress ECG — A randomized prospective study of suspected acute coronary syndrome chest pain in the emergency department (CT-COMPARE). Int J Cardiol 2014; 177:867-73. [DOI: 10.1016/j.ijcard.2014.10.090] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 10/07/2014] [Accepted: 10/18/2014] [Indexed: 11/16/2022]
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Abstract
Calcium artery calcium (CAC) scoring has become an integral part in the era of preventive cardiology, it has been extensively studied and been validated as a powerful tool for cardiovascular risk assessment in conjunction with other traditional well established scoring systems such as Framingham risk score. In addition, CAC testing has found its way into emergency department algorithms assessing low to intermediate risk patients presenting with chest pain, this strategy was recently adopted by the UK NICE guidelines, confidently ruling out cardiac origin of chest pain. Several studies have demonstrated that risk assessment using CAC was motivational to patients leading to better adherence to their preventive practices as well as to medications. Accordingly, this test has several recommendations for use by national and international guidelines.
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Branch KR, Strote J, Shuman WP, Mitsumori LM, Busey JM, Rue T, Caldwell JH. Diagnostic accuracy and clinical outcomes of ECG-gated, whole chest CT in the emergency department. PLoS One 2013; 8:e61121. [PMID: 23613797 PMCID: PMC3629052 DOI: 10.1371/journal.pone.0061121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 03/06/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The purpose of this study was to assess the diagnostic accuracy and one year prognosis of whole chest, "multiple rule out" CT for coronary artery disease (CAD) in Emergency Department patients. METHODS AND FINDINGS One hundred and two Emergency Department patients at low to intermediate risk of acute coronary syndrome (ACS), pulmonary embolism and/or acute aortic syndrome underwent a research 64 channel ECG-gated, whole chest CT and a standard of care evaluation. Patients were classified with obstructive CAD with either a coronary CT stenosis greater than 50% or a non-evaluable coronary segment. SOC and 3 month follow up data were used to determine an adjudicated clinical diagnosis. The diagnostic ability of obstructive CAD on CT to identify clinical diagnoses was determined. Patients were followed up for 1 year for cardiac events. Seven (7%) patients were diagnosed with ACS. CT sensitivity to detect obstructive CAD in ACS patients was 100% (95% CI 65%, 100%), negative predictive value 100% (96%, 100%), specificity 88% (80%, 94%), and positive predictive value 39% (17%, 64%). Pulmonary embolism and acute aortic syndrome were not identified in any patients. No cardiac events occurred in patients without obstructive CAD over 1 year. CONCLUSIONS Whole chest CT has high sensitivity and negative predictive value for ACS with excellent one year prognosis in patients without obstructive CAD on CT. The frequency of pulmonary embolism or acute aortic syndrome and the higher radiation dose suggest whole chest CT should be limited to select patients. ClinicalTrials.org #: NCT00855231.
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Affiliation(s)
- Kelley R Branch
- Division of Cardiology, University of Washington, Seattle, Washington, United States of America.
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Coronary Computed Tomography Angiography: Costs and Current Reimbursement Status. CURRENT CARDIOVASCULAR IMAGING REPORTS 2012. [DOI: 10.1007/s12410-012-9158-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Tota-Maharaj R, McEvoy JW, Blaha MJ, Silverman MG, Nasir K, Blumenthal RS. Utility of coronary artery calcium scoring in the evaluation of patients with chest pain. Crit Pathw Cardiol 2012; 11:99-106. [PMID: 22825529 DOI: 10.1097/hpc.0b013e31825b1429] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although coronary artery calcium (CAC) scoring has an established role in risk-stratifying asymptomatic patients at intermediate risk of coronary heart disease (CHD), its utility in the evaluation of patients with chest pain is uncertain. We conducted a literature review of articles investigating the utility of: (1) CAC scoring in elective patients with indeterminate chest pain symptoms, (2) CAC as a "gatekeeper" in the triage of patients presenting to the emergency department (ED) with chest pain, and (3) the cost-effectiveness of the use of CAC scoring in the ED. We also evaluated the predictive accuracy of the absence of CAC in a pooled analysis of applicable studies. Only studies evaluating patients classified as low or intermediate risk were included. Low to intermediate risk was established by Framingham risk scores, Thrombolysis in Myocardial Infarction scores, Diamond-Forrester classification, or by the absence of typical angina symptoms, ischemic electrocardiogram, positive cardiac biomarkers, or a prior history of CHD. In our pooled analysis, the presence of any CAC resulted in a high sensitivity (range 70%-100%) for predicting the presence of obstructive coronary disease among symptomatic patients subsequently referred for coronary angiography. More importantly, a CAC score of 0 in low- and intermediate-risk ED populations with chest pain had a high negative predictive value (99.4%) for CHD events over an average follow-up of 21 months. CAC scoring also seems cost-effective in this population. Although further research is needed, carefully selected ED patients with a normal electrocardiogram, normal cardiac biomarkers, and CAC = 0 may be considered for early discharge without further testing.
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Affiliation(s)
- Rajesh Tota-Maharaj
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Baltimore, MD 21287, USA
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Schoepf UJ. Comparative effectiveness research in cardiovascular imaging survival of the fittest? Acad Radiol 2012; 19:263-4. [PMID: 22310522 DOI: 10.1016/j.acra.2011.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 12/23/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
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