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Radiation dose of coronary CT angiography with a third-generation dual-source CT in a “real-world” patient population

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Abstract

Objectives

To assess radiation dose and image quality of coronary computed tomography angiography (cCTA) with a third-generation dual-source scanner in a real-world patient population.

Methods

Scans of otherwise unselected, consecutive patients referred for clinically indicated cCTA between June 2015 and November 2017 were included for retrospective analysis. Scan protocol was based on heart rate: prospectively ECG-gated high-pitch spiral below 60 beats per minute (bpm), prospectively ECG-gated sequential scan between 61 and 70 bpm, and retrospective spiral above 70 bmp or at irregular heart rates. Objective image quality was measured as signal-to-noise (SNR) and contrast-to-noise ratio (CNR); subjective image quality was evaluated using a five-point Likert scale by two independent readers. For radiation dose analysis, effective dose, size-specific dose estimates, and volume CT dose index were assessed.

Results

Two hundred seventy-eight patients (median age, 60 years; 155 men) with a median body mass index of 26.6 kg/m2 (range, 16.7–60.9 kg/m2; 180 (64.7%) overweight or obese) were included (122 in the high-pitch spiral group, 60 in the prospective sequence group, and 96 in the retrospective spiral group). Median effective dose was 0.63 mSv (interquartile range [IQR], 0.51–0.90 mSv) for high-pitch spiral, 1.32 mSv (IQR, 0.79–2.46 mSv) for prospective sequence, and 4.77 (IQR, 3.02–8.27 mSv) for retrospective spiral (p < 0.001). Most studies had at least very good image quality (91.4/88.8% R1/R2), with highest SNR and CNR in the high-pitch spiral group.

Conclusions

cCTA with sufficient image quality is achievable at reasonably low radiation exposure in a real-world patient collective with a high proportion of overweight or obese patients.

Key Points

• Submillisievert radiation dose coronary CT angiography with good diagnostic image quality is feasible in the majority of cases in a real-world patient using high-pitch spiral.

• Prospective sequence results in about double median effective dose compared to the high-pitch protocol.

• To optimize individual radiation exposure, lowering the heart rate is paramount, as it allows for choosing a dose-optimized (high-pitch spiral) scan protocol.

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Abbreviations

CAD:

Coronary artery disease

cCTA:

Coronary computed tomography angiography

CNR:

Contrast-to-noise ratio

CT:

Computed tomography

CTDIvol :

Volume computed tomography dose index

DLP:

Dose-length product

ECG:

Electro cardiogram

ROI:

Region of interest

SNR:

Signal-to-noise ratio

SSDE:

Size-specific dose estimates

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacherstrasse 6, 97080, Würzburg, Germany

    Aleksander Kosmala, Bernhard Petritsch, Andreas Max Weng, Thorsten Alexander Bley & Tobias Gassenmaier

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  1. Aleksander Kosmala
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  2. Bernhard Petritsch
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  5. Tobias Gassenmaier
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Corresponding author

Correspondence to Tobias Gassenmaier.

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The scientific guarantor of this publication is Tobias Gassenmaier.

Conflict of interest

The authors declare that they have no conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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Kosmala, A., Petritsch, B., Weng, A.M. et al. Radiation dose of coronary CT angiography with a third-generation dual-source CT in a “real-world” patient population. Eur Radiol 29, 4341–4348 (2019). https://doi.org/10.1007/s00330-018-5856-6

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