Total Effective Radiation Dose Attributable to Medical Imaging in Patients With Acute Chest Pain: A Single-Center Comparison Study Between Dual-Source Coronary CT Angiography and Usual Care

This is an initial report on the use of the recently introduced whole-heart 320-slice computed tomography (CT) scanner for noninvasive coronary angiography compared with conventional coronary angiography (CCA). Whole-heart CT avoids overscanning and overranging as necessary for helical coronary CT acquisitions thereby significantly reducing the effective radiation dose. Twelve patients with suspected coronary artery disease (4 women, 8 men; mean age 64.6 ± 11 years) have undergone coronary CT angiography using a 320-slice scanner (Aquilion ONE, Toshiba; 0.35 s gantry rotation time, 120 kV, and 350 – 450 mA) prior to clinically indicated CCA. CT images were manually reconstructed in motion-free phases with 0.5-mm slice thickness and 0.25-mm slice increment. Independent blinded assessment of CT and CCA (using quantitative analysis) was performed to detect significant (at least 50%) diameter stenoses. Of the 12 patients, in 8 patients, single-heart beat CT acquisition was performed, resulting in an effective dose of 5.6 ± 1.1 mSv and an image reconstruction window length of 175 msec. In the other 4 patients, because of higher heart rates, 2 or 3 heart beats were used for acquisition, resulting in higher radiation exposure (on average 17 mSv) and the possibility to perform multisegment reconstruction with improved temporal resolution (88 and 58 msec image reconstruction windows, respectively). Per-patient sensitivity and specificity for CT compared to CCA were 100%. Per-vessel sensitivity and specificity were 88% and 95%, respectively. Intraindividual comparison of CT with CCA revealed a nonsignificantly smaller effective radiation dose (9.4 ± 7.2 mSv vs. 10.5 ± 5.3 mSv, p<0.69) but significantly smaller contrast agent amount (80 ±0 ml vs. 107.3 ± 17.8 ml, p<0.01) for 320-slice CT. Whole-heart CT significantly reduces the contrast agent amount compared to CCA while radiation exposure is reduced in patients with slow heart rates. This initial report also indicates that diagnostic accuracy of coronary CT angiography using up to 320 simultaneous detector rows remains high as compared with CCA as the reference standard.

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Investigating Decrease in Radiation Dose using Acute Chest Pain Coronary CT with 128 slice MDCT Scanner

Korean Society of Computed Tomographic Technology ◽

10.31320/jksct.2018.20.1.23 ◽

2018 ◽

Vol 20 (1) ◽

pp. 23-32

Author(s):

Yong-Seob Kim ◽

◽

Cheon-Ung Park ◽

Eun-Jung Kim ◽

Sook-Hee Lee ◽

...

Keyword(s):

Chest Pain ◽

Radiation Dose ◽

Acute Chest Pain ◽

Coronary Ct ◽

Mdct Scanner

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Simulated Radiation Dose Reduction in Whole-Body CT on a 3rd Generation Dual-Source Scanner: An Intraindividual Comparison

Diagnostics ◽

10.3390/diagnostics11010118 ◽

2021 ◽

Vol 11 (1) ◽

pp. 118

Author(s):

Andreas S. Brendlin ◽

Moritz T. Winkelmann ◽

Phuong Linh Do ◽

Vincent Schwarze ◽

Felix Peisen ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Dose Reduction ◽

Whole Body ◽

Reference Standard ◽

Diagnostic Confidence ◽

Effective Radiation Dose ◽

Intraindividual Comparison ◽

Dual Source ◽

Effective Radiation

To evaluate the effect of radiation dose reduction on image quality and diagnostic confidence in contrast-enhanced whole-body computed tomography (WBCT) staging. We randomly selected March 2016 for retrospective inclusion of 18 consecutive patients (14 female, 60 ± 15 years) with clinically indicated WBCT staging on the same 3rd generation dual-source CT. Using low-dose simulations, we created data sets with 100, 80, 60, 40, and 20% of the original radiation dose. Each set was reconstructed using filtered back projection (FBP) and Advanced Modeled Iterative Reconstruction (ADMIRE®, Siemens Healthineers, Forchheim, Germany) strength 1–5, resulting in 540 datasets total. ADMIRE 2 was the reference standard for intraindividual comparison. The effective radiation dose was calculated using commercially available software. For comparison of objective image quality, noise assessments of subcutaneous adipose tissue regions were performed automatically using the software. Three radiologists blinded to the study evaluated image quality and diagnostic confidence independently on an equidistant 5-point Likert scale (1 = poor to 5 = excellent). At 100%, the effective radiation dose in our population was 13.3 ± 9.1 mSv. At 20% radiation dose, it was possible to obtain comparably low noise levels when using ADMIRE 5 (p = 1.000, r = 0.29). We identified ADMIRE 3 at 40% radiation dose (5.3 ± 3.6 mSv) as the lowest achievable radiation dose with image quality and diagnostic confidence equal to our reference standard (p = 1.000, r > 0.4). The inter-rater agreement for this result was almost perfect (ICC ≥ 0.958, 95% CI 0.909–0.983). On a 3rd generation scanner, it is feasible to maintain good subjective image quality, diagnostic confidence, and image noise in single-energy WBCT staging at dose levels as low as 40% of the original dose (5.3 ± 3.6 mSv), when using ADMIRE 3.

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Radiation Dose at Coronary CT Angiography: Second-Generation Dual-Source CT Versus Single-Source 64-MDCT and First-Generation Dual-Source CT

American Journal of Roentgenology ◽

10.2214/ajr.10.5153 ◽

2011 ◽

Vol 196 (5) ◽

pp. W550-W557 ◽

Cited By ~ 42

Author(s):

Christian Fink ◽

Radko Krissak ◽

Thomas Henzler ◽

Ursula Lechel ◽

Gunnar Brix ◽

...

Keyword(s):

Radiation Dose ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

First Generation ◽

Second Generation ◽

Dual Source Ct ◽

Single Source ◽

Coronary Ct ◽

Dual Source

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High-Risk Plaque Detected on Coronary CT Angiography Predicts Acute Coronary Syndromes Independent of Significant Stenosis in Acute Chest Pain: Results from the Romicat-II Trial

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2014.11.013 ◽

2015 ◽

Vol 48 (1) ◽

pp. 130

Author(s):

Stephanie Oberfoell

Keyword(s):

Chest Pain ◽

High Risk ◽

Ct Angiography ◽

Acute Coronary Syndromes ◽

Coronary Ct Angiography ◽

Acute Chest Pain ◽

Significant Stenosis ◽

Coronary Ct ◽

Coronary Syndromes

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Coronary CT angiography with single-source and dual-source CT: Comparison of image quality and radiation dose between prospective ECG-triggered and retrospective ECG-gated protocols

International Journal of Cardiology ◽

10.1016/j.ijcard.2012.09.217 ◽

2013 ◽

Vol 168 (2) ◽

pp. 746-753 ◽

Cited By ~ 10

Author(s):

Akmal Sabarudin ◽

Zhonghua Sun ◽

Ahmad Khairuddin Md Yusof

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Ct Angiography ◽

Coronary Ct Angiography ◽

Dual Source Ct ◽

Single Source ◽

Coronary Ct ◽

Dual Source

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Coronary CT angiography decreases the length of stay in emergency department versus standard therapy in patients presenting with acute chest pain, but results in increased downstream testing and radiation exposure

Evidence-Based Medicine ◽

10.1136/eb-2012-101011 ◽

2012 ◽

Vol 18 (4) ◽

pp. 146-147 ◽

Cited By ~ 2

Author(s):

James K Min ◽

Reza Arsanjani

Keyword(s):

Emergency Department ◽

Chest Pain ◽

Length Of Stay ◽

Radiation Exposure ◽

Ct Angiography ◽

Standard Therapy ◽

Coronary Ct Angiography ◽

Acute Chest Pain ◽

Coronary Ct

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Image quality of low-radiation dose left atrial CT using filtered back projection and an iterative reconstruction algorithm: intra-individual comparison in unselected patients undergoing pulmonary vein isolation

Acta Radiologica ◽

10.1177/0284185117708472 ◽

2017 ◽

Vol 59 (2) ◽

pp. 161-169

Author(s):

Ute Lina Fahlenkamp ◽

Ivan Diaz Ramirez ◽

Moritz Wagner ◽

Carsten Schwenke ◽

Alexander Huppertz ◽

...

Keyword(s):

Image Quality ◽

Radiation Dose ◽

Dual Source Ct ◽

Back Projection ◽

Reconstruction Algorithms ◽

Effective Radiation Dose ◽

Subjective Image Quality ◽

Low Radiation Dose ◽

Dual Source ◽

Effective Radiation

Background Computed tomography (CT) of the left atrium (LA) is performed prior to pulmonary vein isolation (PVI) to improve success of circumferential ablation for atrial fibrillation. The ablation procedure itself exposes patients to substantial radiation doses, therefore radiation dose reduction in pre-ablational imaging is of concern. Purpose To assess and compare diagnostic performance of low-radiation dose preprocedural CT in patients scheduled for PVI using two types of reconstruction algorithms. Material and Methods Forty-six patients (61 ± 10 years) scheduled for PVI were enrolled in this study irrespective of body-mass-index or cardiac rhythm at examination. An electrocardiographically triggered dual-source CT scan was performed. Filtered back projection (FBP) and iterative reconstruction (IR) algorithms were applied. Images were integrated into an electroanatomic mapping (EAM) system. Subjective image quality was scored independently by two readers on a five-point scale for both reconstruction algorithms (1 = excellent to 5 = non-diagnostic). Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and effective radiation dose were calculated. Results Data acquisition and EAM integration were successful in all patients. Median image quality score was 1 for both FBP (quartiles = 1, 1.62; range = 1–3) and IR (quartiles = 1, 1.5; range = 1–3). Mean SNR was 7.61 ± 2.14 for FBP and 9.02 ± 2.69 for IR. Mean CNR was 5.92 ± 1.80 for FBP and 6.95 ± 2.29 for IR. Mean effective radiation dose was 0.3 ± 0.1 mSv. Conclusion At a radiation dose of 0.3 ± 0.1 mSv, high-pitch dual-source CT yields LA images of consistently high quality using both FBP and IR. IR raises SNR and CNR without significantly improving subjective image quality.

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