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Comparison of Image Quality and Radiation Dose of Coronary Computed Tomographic Angiography Between Conventional Helical Scanning and a Strategy Incorporating Sequential Scanning

Published:September 28, 2009DOI:https://doi.org/10.1016/j.amjcard.2009.07.003
      Radiation dose from coronary computed tomographic angiography may be decreased using a sequential scanning protocol rather than a conventional helical scanning protocol. We compared radiation dose and image quality from coronary computed tomographic angiography in a single center between an initial period during which helical scanning with electrocardiographically controlled tube current modulation was used for all patients (n = 138) and after adoption of a strategy incorporating sequential scanning whenever appropriate (n = 261). Using the sequential-if-appropriate strategy, sequential scanning was employed in 86.2% of patients. Compared to the helical-only strategy, this strategy was associated with a 65.1% dose decrease (mean dose–length product [DLP] 305.2 vs 875.1 and mean effective dose 14.9 vs 5.2 mSv, respectively), with no significant change in overall image quality, step artifacts, motion artifacts, or perceived image noise. For the 225 patients undergoing sequential scanning, the DLP was 201.9 ± 90.0 mGy × cm; for patients undergoing helical scanning under either strategy, the DLP was 890.9 ± 293.3 mGy × cm (p <0.0001), corresponding to mean effective doses of 3.4 and 15.1 mSv, respectively, a 77.5% decrease. Image quality was significantly greater for the sequential studies, reflecting the poorer image quality in patients undergoing helical scanning in the sequential-if-appropriate strategy. In conclusion, a sequential-if-appropriate diagnostic strategy decreases dose markedly compared to a helical-only strategy, with no significant difference in image quality.
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      References

        • Budoff M.J.
        • Achenbach S.
        • Blumenthal R.S.
        • Carr J.J.
        • Goldin J.G.
        • Greenland P.
        • Guerci A.D.
        • Lima J.A.C.
        • Rader D.J.
        • Rubin G.D.
        • Shaw L.J.
        • Wiegers S.E.
        Assessment of coronary artery disease by cardiac computed tomography: a scientific statement from the American Heart Association Committee on Cardiovascular Imaging and Intervention, Council on Cardiovascular Radiology and Intervention, and Committee on Cardiac Imaging, Council on Clinical Cardiology.
        Circulation. 2006; 114: 1761-1791
        • Nieman K.
        • Cademartiri F.
        • Lemos P.
        • Raaijmakers R.
        • Pattynama P.M.T.
        • de Feyter P.J.
        Reliable noninvasive coronary angiography with fast submillimeter multislice spiral computed tomography.
        Circulation. 2002; 106: 2051-2054
        • Meijboom W.B.
        • van Mieghem C.A.G.
        • Mollet N.R.
        • Pugliese F.
        • Weustink A.C.
        • van Pelt N.
        • Cademartiri F.
        • Nieman K.
        • Boersma E.
        • de Jaegere P.
        • Krestin G.P.
        • de Feyter P.J.
        64-Slice computed tomography coronary angiography in patients with high, intermediate, or low pretest probability of significant coronary artery stenosis.
        J Am Coll Cardiol. 2007; 50: 1469-1475
        • Meijboom W.B.
        • Meijs M.F.L.
        • Schuijf J.D.
        • Cramer M.J.
        • Mollet N.R.
        • van Mieghem C.A.G.
        • Nieman K.
        • van Werkhoven J.M.
        • Pundziute G.
        • Weustink A.N.
        • de Vos A.M.
        • Pugliese F.
        • Rensing B.
        • Jukema J.W.
        • Bax J.J.
        • Prokop M.
        • Doevendans P.A.
        • Hunink M.G.M.
        • Krestin G.P.
        • de Feyter P.J.
        Diagnostic accuracy of 64-slice computed tomography coronary angiography.
        J Am Coll Cardiol. 2008; 52: 2135-2144
        • Einstein A.J.
        • Moser K.W.
        • Thompson R.C.
        • Cerqueira M.D.
        • Henzlova M.D.
        Radiation dose to patients from cardiac diagnostic imaging.
        Circulation. 2007; 116: 1290-1305
        • Coles D.R.
        • Smail M.A.
        • Negus I.S.
        • Wilde P.
        • Oberhoff M.
        • Karsch K.R.
        • Baumbach A.
        Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography.
        J Am Coll Cardiol. 2006; 47: 1840-1845
        • Leung K.C.
        • Martic C.J.
        Effective doses for coronary angiography.
        Br J Radiol. 1996; 69: 426-431
        • Einstein A.J.
        • Henzlova M.J.
        • Rajagopalan S.
        Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography.
        JAMA. 2007; 298: 317-323
        • Hausleiter J.
        • Meyer T.
        • Hermann F.
        • Hadamitzky M.
        • Krebs M.
        • Gerber T.C.
        • McCollough C.
        • Martinoff S.
        • Kastrati A.
        • Schomig A.
        • Achenbach S.
        Estimated radiation dose associated with cardiac CT angiography.
        JAMA. 2009; 301: 500-507
        • Jakobs T.F.
        • Becker C.R.
        • Ohnesorge B.
        • Flohr T.
        • Suess C.
        • Schoepf U.J.
        • Reiser M.F.
        Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation.
        Eur Radiol. 2002; 12: 1081-1086
        • Abada H.T.
        • Larchez C.
        • Daoud B.
        • Sigal-Cinqualbre A.
        • Paul J.F.
        MDCT of the coronary arteries: feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose.
        Am J Roentgenol. 2006; 186: S387-S390
        • Hsieh J.
        • Londt J.
        • Vass M.
        • Li J.
        • Tang X.
        • Okerlund D.
        Step-and-shoot data acquisition and reconstruction for cardiac x-ray computed tomography.
        Med Phys. 2006; 33: 4236-4248
      1. European guidelines on quality criteria for computed tomography.
        (Accessed August 5, 2009)
        • Landis J.R.
        • Koch G.G.
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Gutstein A.
        • Wolak A.
        • Lee C.
        • Dey D.
        • Ohba M.
        • Suzuki Y.
        • Cheng V.
        • Gransar H.
        • Suzuki S.
        • Friedman J.
        • Thomson L.E.
        • Hayes S.
        • Pimentel R.
        • Paz W.
        • Slomka P.
        • Berman D.S.
        Predicting success of prospective and retrospective gating with dual-source coronary computed tomography angiography: development of selection criteria and initial experience.
        J Cardiovasc Comput Tomogr. 2008; 2: 81-90
        • Hirai N.
        • Horiguchi J.
        • Fukioka C.
        • Kiguchi M.
        • Yamamoto H.
        • Matsuura N.
        • Kitagawa T.
        • Kohno N.
        • Ito K.
        Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose.
        Radiology. 2008; 248: 424-430
        • Shuman W.P.
        • Branch K.R.
        • May J.M.
        • Mitsumori L.M.
        • Lockhart D.W.
        • Dubinsky T.J.
        • Warren B.H.
        • Caldwell J.H.
        Prospective versus retrospective ECG gating for 64-detector CT of the coronary arteries: comparison of image quality and patient radiation dose.
        Radiology. 2008; 248: 431-437
        • Earls J.P.
        • Berman E.L.
        • Urban B.A.
        • Curry C.A.
        • Lane J.L.
        • Jennings R.S.
        • McCulloch C.C.
        • Hsieh J.
        • Londt J.H.
        Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose.
        Radiology. 2008; 246: 742-753
        • Hausleiter J.
        • Meyer T.
        • Hadamitzky M.
        • Huber E.
        • Zankl M.
        • Martinoff S.
        • Kastrati A.
        • Schomig A.
        Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates.
        Circulation. 2006; 113: 1305-1310
        • Alkadhi H.
        • Stolzmann P.
        • Scheffel H.
        • Desbiolles L.
        • Baumuller S.
        • Plass A.
        • Genoni M.
        • Marincek B.
        • Leschka S.
        Radiation dose of cardiac dual-source CT: the effect of tailoring the protocol to patient-specific parameters.
        Eur J Radiol. 2008; 68: 385-391
        • Scheffel H.
        • Alkadhi H.
        • Leschka S.
        • Plass A.
        • Desbiolles L.
        • Guber I.
        • Krauss T.
        • Gruenenfelder J.
        • Genoni M.
        • Luescher T.F.
        • Marincek B.
        • Stolzmann P.
        Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance.
        Heart. 2008; 94: 1132-1137
        • Husmann L.
        • Valenta I.
        • Gaemperli O.
        • Adda O.
        • Treyer V.
        • Wyss C.A.
        • Veit-Haibach P.
        • Tatsugami F.
        • von Schulthess G.K.
        • Kaufmann P.A.
        Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating.
        Eur Heart J. 2008; 29: 191-197
        • Horiguchi J.
        • Kiguchi M.
        • Fujioka C.
        • Shen Y.
        • Arie R.
        • Sunasaka K.
        • Ito K.
        Radiation dose, image quality, stenosis measurement, and CT densitometry using ECG-triggered coronary 64-MDCT angiography: a phantom study.
        Am J Roentgenol. 2008; 190: 315-320
        • Earls J.P.
        • Schrack E.C.
        Prospectively gated low-dose CCTA: 24 months experience in more than 2,000 clinical cases.
        Int J Cardiovasc Imaging. 2009; 25: 177-187
        • Gutstein A.
        • Dey D.
        • Cheng V.
        • Wolak A.
        • Gransar H.
        • Suzuki Y.
        • Friedman J.
        • Thomson L.E.J.
        • Hayes S.
        • Pimentel R.
        • Paz W.
        • Slomka P.
        • LeMeunier L.
        • Germano G.
        • Berman D.S.
        Algorithm for radiation dose reduction with helical dual source coronary computed tomography angiography in clinical practice.
        J Cardiovasc Comput Tomogr. 2008; 2: 311-322
        • Meyer T.
        • Hein F.
        • Martinoff S.
        • Schoemig A.
        • Hausleiter J.
        Radiation exposure and dose reduction measures in cardiac CT.
        Curr Cardiovasc Imaging Rep. 2008; 1: 133-140
        • Primak A.N.
        • McCollough C.H.
        • Bruesewitz M.R.
        • Zhang J.
        • Fletcher J.G.
        Relationship between noise, dose, and pitch in cardiac multi-detector row CT.
        Radiographics. 2006; 26: 1785-1794
        • Fryback D.G.
        • Thornbury J.R.
        The efficacy of diagnostic imaging.
        Med Decis Making. 1991; 11: 88-94