Evolution of coronary computed tomography radiation dose reduction at a tertiary referral center.

PURPOSE We aimed to assess the temporal change in radiation doses from coronary computed tomography angiography (CCTA) during a 6-year period. High CCTA radiation doses have been reduced by multiple technologies that, if used appropriately, can decrease exposures significantly. METHODS A total of 1277 examinations performed from 2005 to 2010 were included. Univariate and multivariable regression analysis of patient- and scan-related variables was performed with estimated radiation dose as the main outcome measure. RESULTS Median doses decreased by 74.8% (P<.001), from 13.1 millisieverts (mSv) (interquartile range 9.3-14.7) in period 1 to 3.3 mSv (1.8-6.7) in period 4. Factors associated with greatest dose reductions (P<.001) were all most frequently applied in period 4: axial-sequential acquisition (univariate: -8.0 mSv [-9.7 to -7.9]), high-pitch helical acquisition (univariate: -8.8 mSv [-9.3 to -7.9]), reduced tube voltage (100 vs 120 kV) (univariate: -6.4 mSv [-7.4 to -5.4]), and use of automatic exposure control (univariate: -5.3 mSv [-6.2 to -4.4]). CONCLUSIONS CCTA radiation doses were reduced 74.8% through increasing use of dose-saving measures and evolving scanner technology.

[1]  D. Brenner,et al.  Computed tomography--an increasing source of radiation exposure. , 2007, The New England journal of medicine.

[2]  N. Bellenger,et al.  A comparison of radiation doses between state-of-the-art multislice CT coronary angiography with iterative reconstruction, multislice CT coronary angiography with standard filtered back-projection and invasive diagnostic coronary angiography , 2010, Heart.

[3]  T. Callister,et al.  SCCT guidelines for performance of coronary computed tomographic angiography: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. , 2009, Journal of cardiovascular computed tomography.

[4]  G. Feuchtner,et al.  Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: first experience , 2009, European Radiology.

[5]  Masanori Takada,et al.  Radiation dose reduction and coronary assessability of prospective electrocardiogram-gated computed tomography coronary angiography: comparison with retrospective electrocardiogram-gated helical scan. , 2008, Journal of the American College of Cardiology.

[6]  J. Leipsic,et al.  Effect of a standardized quality-improvement protocol on radiation dose in coronary computed tomographic angiography. , 2010, The American journal of cardiology.

[7]  Thomas Flohr,et al.  High-pitch spiral acquisition: a new scan mode for coronary CT angiography. , 2009, Journal of cardiovascular computed tomography.

[8]  Jörg Hausleiter,et al.  Estimated radiation dose associated with cardiac CT angiography. , 2009, JAMA.

[9]  Reduction of Radiation Dose Estimates in Cardiac 64-Slice CT Angiography in Patients After Coronary Artery Bypass Graft Surgery , 2008, Investigative radiology.

[10]  Masao Kiguchi,et al.  Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose. , 2008, Radiology.

[11]  K. Chinnaiyan,et al.  Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. , 2009, JAMA.

[12]  G. Feuchtner,et al.  Low-dose, 128-slice, dual-source CT coronary angiography: accuracy and radiation dose of the high-pitch and the step-and-shoot mode , 2010, Heart.

[13]  D. Berman,et al.  The present state of coronary computed tomography angiography a process in evolution. , 2010, Journal of the American College of Cardiology.

[14]  H. Alkadhi,et al.  Radiation dose of cardiac dual-source CT: the effect of tailoring the protocol to patient-specific parameters. , 2008, European journal of radiology.

[15]  T. Villines,et al.  International, multidisciplinary update of the 2006 Appropriateness Criteria for cardiac computed tomography. , 2009, Journal of cardiovascular computed tomography.

[16]  David W. Bates,et al.  Synthesis of Research Paper: Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality , 2003, J. Am. Medical Informatics Assoc..

[17]  S. Achenbach,et al.  Iterative reconstruction in image space (IRIS) in cardiac computed tomography: initial experience , 2011, The International Journal of Cardiovascular Imaging.

[18]  S. Wildermuth,et al.  Dual-source CT in step-and-shoot mode: noninvasive coronary angiography with low radiation dose. , 2008, Radiology.

[19]  J. Leipsic,et al.  Effect of a standardized radiation dose reduction protocol on diagnostic accuracy of coronary computed tomographic angiography. , 2010, The American journal of cardiology.

[20]  Bernhard Bischoff,et al.  Image quality and radiation exposure with a low tube voltage protocol for coronary CT angiography results of the PROTECTION II Trial. , 2010, JACC. Cardiovascular imaging.

[21]  S. Abbara.  ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography , 2011 .

[22]  A. Schmermund,et al.  Use of automatic exposure control in multislice computed tomography of the coronaries: comparison of 16-slice and 64-slice scanner data with conventional coronary angiography , 2007, Heart.

[23]  L Desbiolles,et al.  Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance , 2008, Heart.

[24]  T. Brady,et al.  Direct chest area measurement: A potential anthropometric replacement for BMI to inform cardiac CT dose parameters? , 2011, Journal of cardiovascular computed tomography.

[25]  M. Jinzaki,et al.  ASCI 2010 appropriateness criteria for cardiac computed tomography: a report of the Asian Society of Cardiovascular Imaging cardiac computed tomography and cardiac magnetic resonance imaging guideline Working Group , 2010, The International Journal of Cardiovascular Imaging.

[26]  Simon Wildermuth,et al.  Low kilovoltage cardiac dual-source CT: attenuation, noise, and radiation dose , 2008, European Radiology.

[27]  S. Achenbach,et al.  Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. , 2010, European heart journal.

[28]  G. Raff,et al.  SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. , 2011, Journal of cardiovascular computed tomography.

[29]  Jörg Hausleiter,et al.  Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice: Impact of Different Scanning Protocols on Effective Dose Estimates , 2006, Circulation.