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Kim SJ, Kim MH, Kang EJ. Comparison of the radiation dose between dual-acquisition coronary computed tomography angiography and coronary angiography for coronary spasm. KOSIN MEDICAL JOURNAL 2022. [DOI: 10.7180/kmj.21.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hamilton-Craig CR, Tandon K, Kwan B, DeBoni K, Burley C, Wesley AJ, O'Rourke R, Neill J, Branch KR. Coronary CT radiation dose reduction strategies at an Australian Tertiary Care Center - improvements in radiation exposure through an evidence-based approach. J Med Radiat Sci 2019; 67:25-33. [PMID: 31693313 PMCID: PMC7063243 DOI: 10.1002/jmrs.358] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 08/14/2019] [Accepted: 08/25/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Coronary CT Angiography (CCTA) is a rapidly increasing technique for coronary imaging; however, it exposes patients to ionising radiation. We examined the impact of dose reduction techniques using ECG‐triggering, kVp/mAs reduction and high‐pitch modes on radiation exposure in a large Australian tertiary CCTA service. Methods Data on acquisition modes and dose exposure were prospectively collected on all CCTA scans from November 2009 to March 2014 at an Australian tertiary care centre. A dose reduction algorithm was developed using published techniques and implemented with education of medical staff, radiographers and referrers. Associations of CCTA acquisition to radiation over time were analysed with multivariate regression. Specificity in positive CCTA was assessed by correlation with invasive coronary angiography. Results 3333 CCTAs were analysed. Mean radiation dose decreased from 8.4 mSv to 5.3, 4.4, 3.7, 2.9 and 2.8 mSv (P < 0.001) per year. Patient characteristics were unchanged. Dose reduction strategies using ECG‐triggering, kVp/mAs reduction accounted for 91% of the decrease. High‐pitch scanning reduced dose by an additional 9%. Lower dose was independently related to lower kVp, heart rate, tube current modulation, BMI, prospective triggering and high‐pitch mode (P < 0.01). CCTA specificity remained unchanged despite dose reduction. Conclusion Implementation of evidence‐based CCTA dose reduction algorithm and staff education programme resulted in a 67% reduction in radiation exposure, while maintaining diagnostic specificity. This approach is widely applicable to clinical practice for the performance of CCTA.
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Affiliation(s)
- Christian R Hamilton-Craig
- The Prince Charles Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia.,Griffith University School of Medicine, Sunshine Coast, Queensland, Australia
| | | | - Bianca Kwan
- The Prince Charles Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Karen DeBoni
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Chris Burley
- The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Allan J Wesley
- The Prince Charles Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Rachael O'Rourke
- The Prince Charles Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
| | - Johanne Neill
- The Prince Charles Hospital, Brisbane, Queensland, Australia.,University of Queensland, Brisbane, Queensland, Australia
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Effect of the forward-projected model-based iterative reconstruction solution algorithm on image quality and radiation dose in pediatric cardiac computed tomography. Pediatr Radiol 2016; 46:1663-1670. [PMID: 27531216 DOI: 10.1007/s00247-016-3676-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 05/22/2016] [Accepted: 07/20/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Some iterative reconstruction algorithms are useful for reducing the radiation dose in pediatric cardiac CT. A new iterative reconstruction algorithm (forward-projected model-based iterative reconstruction solution) has been developed, but its usefulness for radiation dose reduction in pediatric cardiac CT is unknown. OBJECTIVE To investigate the effect of the new algorithm on CT image quality and on radiation dose in pediatric cardiac CT. MATERIALS AND METHODS We obtained phantom data at six dose levels, as well as pediatric cardiac CT data, and reconstructed CT images using filtered back projection, adaptive iterative dose reduction 3-D (AIDR 3-D) and the new algorithm. We evaluated phantom image quality using physical assessment. Four radiologists performed visual evaluation of cardiac CT image quality. RESULTS In the phantom study, the new algorithm effectively suppressed noise in the low-dose range and moderately generated modulation transfer function, yielding a higher signal-to-noise ratio compared with filtered back projection or AIDR 3-D. When clinical cardiac CT was performed, images obtained by the new method had less perceived image noise and better tissue contrast at similar resolution compared with AIDR 3-D images. CONCLUSION The new algorithm reduced image noise at moderate resolution in low-dose CT scans and improved the perceived quality of cardiac CT images to some extent. This new algorithm might be superior to AIDR 3-D for radiation dose reduction in pediatric cardiac CT.
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Arampatzis CA, Chourmouzi D, Boulogianni G, Lemos P, Pentousis D, Potsi S, Moumtzouoglou A, Papadopoulou E, Grammenos A, Voucharas C, Mpismpos A, McFadden EP, Drevelengas A. Graft failure prior to discharge after coronary artery bypass surgery: a prospective single-centre study using dual 64-slice computed tomography. EUROINTERVENTION 2016; 12:e972-e978. [DOI: 10.4244/eijv12i8a160] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Levine A, Hecht HS. Cardiac CT Angiography in Congestive Heart Failure. J Nucl Med 2015; 56 Suppl 4:46S-51S. [DOI: 10.2967/jnumed.114.150441] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cui Y, Zhang H, Zheng J, Yang X, Liang C. An investigation of patient doses during coronary interventional procedures in China. RADIATION PROTECTION DOSIMETRY 2013; 156:296-302. [PMID: 23528327 DOI: 10.1093/rpd/nct065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The purpose of this study was to estimate patient doses during coronary angiography (CA) and different complex percutaneous transluminal coronary angioplasty (PTCA) procedures in China. Consecutive 290 patients (90 CA, 200 PTCA) with known or suspected coronary artery disease were enrolled prospectively into six groups. Differences in patient doses among the six groups were analysed, and the patient doses observed in this study were compared with the recent literature. The median dose area product values were 27.0 and 195.0 Gy cm(2) for CA and PTCA, respectively. The patient doses during CA were similar to those reported by other authors, while those during PTCA were higher. The differences in radiation doses depended on the complexity of the procedures. Enhanced knowledge of radiation doses may help cardiologists implement radiation-sparing procedures to minimise patient exposure.
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Affiliation(s)
- Yanhai Cui
- Department of Radiology, Guangdong Academy of Medical Sciences and Guangdong General Hospital, Guangzhou, China
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Sabarudin A, Md Yusof AK, Tay MF, Ng KH, Sun Z. Dual-source CT coronary angiography: effectiveness of radiation dose reduction with lower tube voltage. RADIATION PROTECTION DOSIMETRY 2013; 153:441-7. [PMID: 22807493 DOI: 10.1093/rpd/ncs127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
This study was conducted to investigate the effectiveness of dose-saving protocols in dual-source computed tomography (CT) coronary angiography compared with invasive coronary angiography (ICA). On 50 patients who underwent coronary CT angiography was performed dual-source CT (DSCT) and compared with ICA procedures. Entrance skin dose (ESD), which was measured at the thyroid gland, and effective dose (E) were assessed for both imaging modalities. The mean ESD measured at the thyroid gland was the highest at 120 kVp, followed by the 100 kVp DSCT and the ICA protocols with 4.0±1.8, 2.7±1.0 and 1.1±1.2 mGy, respectively. The mean E was estimated to be 10.3±2.1, 6.2±2.3 and 5.3±3.4 mSv corresponding to the 120-kVp, 100-kVp DSCT and ICA protocols, respectively. The application of 100 kVp in DSCT coronary angiography is feasible only in patients with a low body mass index of <25 kg m(-2), which leads to a significant dose reduction with the radiation dose being equivalent to that of ICA.
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Affiliation(s)
- Akmal Sabarudin
- Diagnostic Imaging & Radiotherapy Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
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CT coronary angiography: coronary CT-flow quantification supplements morphological stenosis analysis. Eur J Radiol 2012; 82:608-16. [PMID: 23265182 DOI: 10.1016/j.ejrad.2012.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 07/29/2012] [Accepted: 08/05/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Our rationale was to evaluate whether a 64-slice CT scanner allows accurate measurement of computed tomographic (CT) changes in coronary artery flow profiles and whether CT flow measurements are suitable for classifying the significance and hemodynamic relevance of a stenosis and thereby supplement as a functional parameter for morphological stenosis analysis. METHODS A total of 50 patients prospectively underwent computed tomography coronary angiography (coronary CTA) in a multidetector CT scanner (Brilliance 64, Philips)±1 day before or after invasive coronary angiography (ICA). Immediately thereafter, 2 radiologists reviewed the imaging data to detect any vessel segments with morphology poorly evaluable by coronary CTA. A locally constant cyclical measurement was acquired in these coronary arteries in breath-hold technique during the passage of a 50ml bolus of contrast media. For analysis, time-density curves of the bolus passage were registered in the coronary artery and the aorta (internal reference), the up-slopes were determined and correlated with each other. The results were compared with the ICA findings. RESULTS 47 of 50 CT flow measurements were evaluable. A good correlation was found between the degrees of stenosis and slope ratios in aorta and coronary artery (R(2)=0.92). The threshold corridor was 0.55-0.77 for distinguishing hemodynamically (≥70%) from non-hemodynamically relevant stenoses. CONCLUSIONS CT-based coronary artery flow measurements (CTFM) correlate well with the angiographically determined degree of stenosis and can elevate by non-invasive means the diagnostic accuracy of coronary CTA. From both a clinically diagnostic and scientific standpoint, CTFM proves a suitable method for quantifying coronary blood flow.
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Sabarudin A, Sun Z, Ng KH. A systematic review of radiation dose associated with different generations of multidetector CT coronary angiography. J Med Imaging Radiat Oncol 2012; 56:5-17. [PMID: 22339741 DOI: 10.1111/j.1754-9485.2011.02335.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The purpose of this paper is to perform a systematic review on radiation dose reduction in coronary computed tomography (CT) angiography that is done using different generations of multidetector CT (MDCT) scanners ranging from four-slice to 320-slice CTs, and have different dose-saving techniques. The method followed was to search for references on coronary CT angiography (CTA) that had been published in English between 1998 and February 2011. The effective radiation dose reported in each study based on different generations of MDCT scanners was analysed and compared between the types of scanners, gender, exposure factors and scanning protocols. Sixty-six studies were eligible for inclusion in this analysis. The mean effective dose (ED) for MDCT angiography with retrospective electrocardiogram (ECG) gating without use of any dose-saving protocol was 6.0 ± 2.8, 10.4 ± 4.90 and 11.8 ± 5.9 mSv for four-slice, 16-slice and 64-slice CTs, respectively. More dose-saving strategies were applied in recent CT generations including prospective ECG-gating protocols, application of lower tube voltage and tube current modulation to achieve a noteworthy dose reduction. Prospective ECG-gating protocol was increasingly used in 64, 125, 256 and 320 slices with corresponding ED of 4.1 ± 1.7, 3.6 ± 0.4, 3.0 ± 1.9 and 7.6 ± 1.6 mSv, respectively. Lower tube voltage and tube current modulation were widely applied in 64-slice CT and resulted in significant dose reduction (P < 0.05). This analysis has shown that dose-saving strategies can substantially reduce the radiation dose in CT coronary angiography. The fact that more and more clinicians are opting for dose-saving strategies in CT coronary angiography indicates an increased awareness of risks associated with high radiation doses among them.
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Affiliation(s)
- Akmal Sabarudin
- Department of Imaging and Applied Physics, Curtin University, Perth, Western Australia, Australia
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Dougeni E, Faulkner K, Panayiotakis G. A review of patient dose and optimisation methods in adult and paediatric CT scanning. Eur J Radiol 2011; 81:e665-83. [PMID: 21684099 DOI: 10.1016/j.ejrad.2011.05.025] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2010] [Revised: 05/18/2011] [Accepted: 05/19/2011] [Indexed: 12/14/2022]
Abstract
An increasing number of publications and international reports on computed tomography (CT) have addressed important issues on optimised imaging practice and patient dose. This is partially due to recent technological developments as well as to the striking rise in the number of CT scans being requested. CT imaging has extended its role to newer applications, such as cardiac CT, CT colonography, angiography and urology. The proportion of paediatric patients undergoing CT scans has also increased. The published scientific literature was reviewed to collect information regarding effective dose levels during the most common CT examinations in adults and paediatrics. Large dose variations were observed (up to 32-fold) with some individual sites exceeding the recommended dose reference levels, indicating a large potential to reduce dose. Current estimates on radiation-related cancer risks are alarming. CT doses account for about 70% of collective dose in the UK and are amongst the highest in diagnostic radiology, however the majority of physicians underestimate the risk, demonstrating a decreased level of awareness. Exposure parameters are not always adjusted appropriately to the clinical question or to patient size, especially for children. Dose reduction techniques, such as tube-current modulation, low-tube voltage protocols, prospective echocardiography-triggered coronary angiography and iterative reconstruction algorithms can substantially decrease doses. An overview of optimisation studies is provided. The justification principle is discussed along with tools that assist clinicians in the decision-making process. There is the potential to eliminate clinically non-indicated CT scans by replacing them with alternative examinations especially for children or patients receiving multiple CT scans.
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Affiliation(s)
- E Dougeni
- Imaging Physics and Radiation Safety Section, Regional Medical Physics Department, Freeman Hospital, Freeman Road, Newcastle Upon Tyne NE7 7DN, UK.
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Comparison of diagnostic accuracy and radiation dose between prospective triggering and retrospective gated coronary angiography by dual-source computed tomography. Am J Cardiol 2011; 107:1278-84. [PMID: 21497209 DOI: 10.1016/j.amjcard.2010.12.038] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 12/31/2010] [Accepted: 12/31/2010] [Indexed: 11/22/2022]
Abstract
The purpose of this study was to evaluate and compare the diagnostic accuracy and radiation dose of dual-source computed tomographic (DSCT) coronary angiography for assessment of coronary artery disease using prospective electrocardiographic triggering and retrospective electrocardiographically (ECG) gated spiral scans. One hundred sixteen patients who had undergone dual-source computed tomography and conventional coronary angiography were enrolled in this study. Fifty-four patients were scanned using retrospective ECG-gated protocols (group 1) and 62 patients using prospective ECG-triggered protocols (group 2). Diagnostic accuracy, image quality, and effective dose were compared between groups 1 and 2. Conventional coronary angiography was used as the reference standard. In total 1,709 (98.2%) coronary segments in the 116 patients were assessable with adequate image quality. Sensitivities and specificities of diagnosing coronary heart disease (≥50% stenosis) in a patient-based analysis of DSCT data were 93.3% and 88.9% in group 1 and 96.4% and 85.7% in group 2, respectively (p=0.973 and 0.761). In vessel-based analysis, sensitivities and specificities were 77.4% and 94.1% in group 1 and 79.6% and 92.3% in group 2 (p=0.983 and 0.985). Overall averaged image quality scores (using 1- to 4-point scale) in groups 1 and 2 were 3.3 ± 0.4 and 3.5 ± 0.9, respectively (p=0.268). Prevalence of good (score 3.0) and excellent (score 4.0) image qualities of coronary vessels were 95.4% in group 1 and 92.4% in group 2 (p = 0.861). Effective doses were 8.82 ± 3.50 mSv (range 3.92 to 15.36) in group 1 and 2.95 ± 1.39 mSv (range 0.99 to 6.06) in group 2 (p<0.001). In conclusion, DSCT prospective ECG-triggered coronary angiography has equivalent image quality and diagnostic value compared to that of retrospective ECG-gated scans. Radiation dose was significantly decreased using prospective electrocardiographic triggering.
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Implications for single phase prospective CT coronary angiography for the diagnosis of significant coronary stenoses in clinical practice. Int J Cardiol 2011; 147:393-7. [DOI: 10.1016/j.ijcard.2009.09.542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Revised: 09/18/2009] [Accepted: 09/26/2009] [Indexed: 11/23/2022]
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Herzog BA, Husmann L, Buechel RR, Pazhenkottil AP, Burger IA, Valenta I, Altorfer U, Wolfrum M, Nkoulou RN, Ghadri JR, Wyss CA, Kaufmann PA. Rapid cardiac hybrid imaging with minimized radiation dose for accurate non-invasive assessment of ischemic coronary artery disease. Int J Cardiol 2010; 153:10-3. [PMID: 20826020 DOI: 10.1016/j.ijcard.2010.08.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 07/09/2010] [Accepted: 08/07/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ischemic coronary artery disease (CAD) is a major cause for morbidity and mortality resulting in a continuously increasing number of diagnostic interventions. We have validated a new hybrid imaging method using minimized radiation dose for rapid non-invasive prediction of invasive coronary angiography (CA) findings with regard to coronary lesion detection and revascularization. METHODS Forty patients referred for elective invasive coronary angiography (CA) due to suspected CAD were prospectively enrolled to undergo a low-dose CTCA with prospective ECG-triggering and a stress-only SPECT-MPI scan administering half of the standard low-dose stress (99m)Tc-tetrofosmin activity. The latter was acquired immediately after adenosine stress (omitting the standard 30-60 min waiting time). After fusing CTCA and SPECT-MPI decisions towards conservative management versus revascularization strategy based on hybrid images were compared to the decisions taken by the interventional operator in the catheterization laboratory based on CA. The latter served as standard of reference. RESULTS Hybrid images yielded sensitivity, specificity, positive and negative predictive values and accuracy of 100%, 96.0%, 100%, 93.8% and 97.5% for predicting coronary revascularization. The estimated mean effective radiation doses were significantly lower for hybrid imaging (4.7 ± 1.0 mSv) than for invasive CA (8.7 ± 4.2 mSv; P<0.001 vs. hybrid). Total non-invasive protocol time was below 60 min, comparing favourably to standard SPECT protocols. CONCLUSIONS Rapid cardiac hybrid imaging allows accurate prediction of invasive CA findings and of treatment decision despite minimized radiation dose and protocol time.
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Marque N, Jégou A, Varenne O, Salengro E, Allouch P, Margot O, Spaulding C. Impact of an extension tube on operator radiation exposure during coronary procedures performed through the radial approach. Arch Cardiovasc Dis 2009; 102:749-54. [DOI: 10.1016/j.acvd.2009.09.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Revised: 08/27/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
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Pantos I, Efstathopoulos EP, Katritsis DG. Two and Three-Dimensional Quantitative Coronary Angiography. Cardiol Clin 2009; 27:491-502. [DOI: 10.1016/j.ccl.2009.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kristensen TS, Engstrøm T, Kelbæk H, von der Recke P, Nielsen MB, Kofoed KF. Correlation between coronary computed tomographic angiography and fractional flow reserve. Int J Cardiol 2009; 144:200-5. [PMID: 19427706 DOI: 10.1016/j.ijcard.2009.04.024] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Revised: 03/31/2009] [Accepted: 04/11/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coronary CT angiography (CCTA) has become an important modality to evaluate the presence of coronary artery disease. Coronary artery stenosis of intermediate severity remains a therapeutic dilemma. Measurement of fractional flow reserve (FFR) during coronary angiography is the most established technique to determine the hemodynamic severity of a coronary artery lesion. The aim of this study was to compare CCTA with FFR. METHODS In 56 coronary artery stenoses (42 patients) we performed CCTA, quantitative coronary angiography and FFR. CCTA measurements included diameter stenosis (DS, %), area stenosis (AS, %), minimal lumen diameter (MLD, mm), minimal lumen area (MLA, mm(2)), lesion length (LL, mm), plaque volume (mm(3)) and burden (%). RESULTS FFR averaged 0.81±0.14, and 10 lesions had an abnormal FFR (<0.75). We found significant correlations between FFR and DS (r=-0.67, p<0.001), AS (r=-0.68, p<0.001), MLD (r=0.58, p<0.001), MLA (r=0.53, p<0.001), LL (r=-0.36, p=0.02), plaque volume (r=-0.36, p=0.02) and plaque burden (r=-0.59, p<0.001). By multivariate regression analysis AS and LL were the strongest determinants of an abnormal FFR. The optimal cut-off value for AS was >73% (sensitivity 90%, specificity 80%, negative predictive value 97%, and positive predictive value 50%) and for LL >10 mm (sensitivity 60% and specificity 49%). CONCLUSION This study demonstrates that quantitative CCTA is correlated to FFR. Using our CCTA criteria of abnormality, significant coronary artery stenoses can be ruled out with a high negative predictive value.
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Pantos I, Patatoukas G, Katritsis DG, Efstathopoulos E. Patient radiation doses in interventional cardiology procedures. Curr Cardiol Rev 2009; 5:1-11. [PMID: 20066141 PMCID: PMC2803281 DOI: 10.2174/157340309787048059] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/01/2008] [Accepted: 08/01/2008] [Indexed: 11/22/2022] Open
Abstract
Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography, percutaneous coronary interventions, diagnostic electrophysiology studies and radiofrequency catheter ablation. Patient radiation dose in these procedures can be assessed either by measurements on a series of patients in real clinical practice or measurements using patient-equivalent phantoms. In this article we review the derived doses at non-pediatric patients from 72 relevant studies published during the last 22 years in international scientific literature. Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. Discrepancies of the derived results are patient-, procedure-, physician-, and fluoroscopic equipmentrelated. Nevertheless, interventional cardiology procedures can subject patients to considerable radiation doses. Efforts to minimize patient exposure should always be undertaken.
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Affiliation(s)
- Ioannis Pantos
- Department of Cardiology, Athens Euroclinic, Athens, Greece
- 2 Department of Radiology, Medical Physics Unit, University of Athens, Athens, Greece
| | - Georgios Patatoukas
- 2 Department of Radiology, Medical Physics Unit, University of Athens, Athens, Greece
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Rixe J, Rolf A, Conradi G, Moellmann H, Nef H, Neumann T, Steiger H, Hamm CW, Dill T. Detection of Relevant Coronary Artery Disease Using Dual-Source Computed Tomography in a High Probability Patient Series Comparison With Invasive Angiography. Circ J 2009; 73:316-22. [DOI: 10.1253/circj.cj-08-0534] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart Centre
| | | | | | - Holger Nef
- Department of Cardiology, Kerckhoff Heart Centre
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Andò G, Saporito F, Cerrito M, Trio O, Gaeta R, Arrigo F, Oreto G. Can we finally get a coronary angiography with the least amount of dye? Int J Cardiol 2008; 130:89-91. [PMID: 17689702 DOI: 10.1016/j.ijcard.2007.06.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Accepted: 06/30/2007] [Indexed: 11/20/2022]
Abstract
The incidence of adverse events complicating coronary angiography is still considerably high. Founded concerns about risks of coronary angiography, and mainly its inherent invasiveness, have favored the increasing request for noninvasive techniques to evaluate the coronary anatomy, such as multislice computed tomography (MSCT). Nonetheless, it has to be kept in mind that several risks and complications are the same both for MSCT and conventional coronary angiography. Rotational angiography has been shown to be a powerful imaging tool for the evaluation of coronary anatomy resulting in the use of less contrast media and less radiation, without losing the possibility to obtain a precise, efficient and fast characterization of obstructive coronary artery disease. It is likely that in the next future the overall performance, taking into account both the diagnostic accuracy and the risk of exposure to radiation and contrast media, of MSCT techniques will have to be compared to that of rotational angiography, especially when the latter is coupled with minimally invasive approaches.
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Non-invasive coronary angiography: the clinical value of multi-slice computed tomography in the assessment of patients with prior coronary bypass surgery. Evaluating grafts and native vessels. Int J Cardiovasc Imaging 2008; 25:161-70. [PMID: 18759133 DOI: 10.1007/s10554-008-9361-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Accepted: 08/13/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contrast enhanced multi-slice computed tomography (MSCT) is the leading modality in non-invasive coronary angiography (CTA) today. We investigated MSCT based assessment of coronary artery bypass grafts (CABG) by analyzing assets and drawbacks of CTA in order to define demands on latest technology. METHODS In a clinical setting 39 CABG patients (69.2 +/- 1.4 years; male n = 36) underwent CTA (collimation 16 x 0.75 mm, contrast medium 100 ml; 320 mAs, 120 KV). Ninety-seven CABG (61 venous, 36 arterial grafts) were evaluated. A subgroup of 18 patients underwent additional invasive coronary angiography (CA). RESULTS CTA for CABG assessment resulted in an overall sensitivity (sens.) of 100%, specificity (spec.) of 92.4% and positive and negative predictive values (PPV, NPV) of 60% and 100%, respectively. CABG anastomoses showed slightly inferior diagnostic accuracy than other CABG segments. Limitations in imaging quality caused 21% unevaluable segments of the CABG anastomoses. Evaluation of native vessel segments proximal and distal to the anastomoses resulted in a sens, spec, PPV and NPV of 57.5, 94.6, 92 and 67.3%, respectively. With 28.5% unevaluable segments, the native vessel segments showed serious limitations in imaging quality. Radiation exposure was 9.88 +/- 3.20 mSv (9.69 +/- 3.25 mSv male; 12.08 +/- 1.35 mSv female). CONCLUSION 16-slice MSCT based CABG assessment offers sufficient diagnostic accuracy. However, focussing on the bypass anastomoses and the native revascularized coronary arteries, clinical value is limited.
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Ratajczak A, Hanssen M, Burguet JL, Couppie P, Reeb T, De Poli F. [Multidetector computed tomography coronarography: preliminary experience in real life settings]. Ann Cardiol Angeiol (Paris) 2007; 56:188-93. [PMID: 17920559 DOI: 10.1016/j.ancard.2007.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED Multidetector computed tomography coronarography (MDCT) is a promising tool, offering non invasive anatomic evaluation of coronary arteries. We relate in this article our impressions after our first two years experience. METHODS Retrospective study of the 328 patients who underwent MDCT examination between January 2005 and December 2006 at our community hospital. Per patient comparative analysis of the anatomical findings versus percutaneous angiography (PCA) in 61 cases. RESULTS Out of 328 patients 61 (18.5%) underwent PCA. In these patients we found a sensibility, specificity, positive predictive value and negative predictive value of 100%, 54%, 59% and 100% for MDCT. The main factor responsible for inconclusive vessel analysis was excessive calcification. CONCLUSION In routine use, MDCT enables one to rule out significant stenosis non invasively, with high sensitivity in an unselected patient population.
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Affiliation(s)
- A Ratajczak
- Pôle cardioneurovasculaire, centre hospitalier de Haguenau, 64, avenue du Professeur-Leriche, 67504 Haguenau, France.
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