Journal of Cardiovascular Computed Tomography
Volume 2, Issue 5 , Pages 311-322, September 2008

Algorithm for radiation dose reduction with helical dual source coronary computed tomography angiography in clinical practice

Presented in part at the Annual Scientific Sessions of the American Heart Association, 2007 and the Annual meeting of the American College of Cardiology, 2008.

  • Ariel Gutstein, MD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • Damini Dey, PhD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    • ,
  • Victor Cheng, MD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • Arik Wolak, MD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • Heidi Gransar, MS

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • Yasuyuki Suzuki, MD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • John Friedman, MD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    • ,
  • Louise E.J. Thomson, MBChB

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • Sean Hayes, MD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • Raymond Pimentel, BSc

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • William Paz, BSc

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • ,
  • Piotr Slomka, PhD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    • ,
  • Ludovic Le Meunier, PhD

      Affiliations

    • Siemens Medical Solutions, PET division, Knoxville, TN, USA
    • ,
  • Guido Germano, PhD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    • ,
  • Daniel S. Berman, MD

      Affiliations

    • Departments of Imaging and the Department of Medicine (Division of Cardiology), Cedars-Sinai Medical Center, Los Angeles, California, USA
    • David Geffen School of Medicine at UCLA, Los Angeles, California, USA
    • Corresponding Author InformationCorresponding author

Received 22 August 2007; accepted 27 February 2008. published online 01 August 2008.

Background

Strategies to reduce the radiation dose of coronary computed tomography angiography (CCTA), while maintaining diagnostic image quality, are imperative for cardiac CT.

Objective

We aimed to reduce radiation dose during helical dual-source CCTA by combining lower tube voltage, shortest possible full tube current (FTC) window, and minimal tube current outside the FTC window, and to develop a patient-based algorithm for applying these dose-reduction components.

Methods

We compared FTC at 70% of the cardiac cycle (FTC70) to a 45% to 75% window (FTC45-75) using both 100 and 120 kVp (N=118). FTC70 was used in patients with heart rates <70 beats/min, no arrhythmia, age <65 years; 100 kVp was used in patients with body mass index (BMI) <30, a low coronary calcium score (CCS), and no stents. Objective and subjective image quality were assessed.

Results

Compared with FTC45-75 at 120 kVp, radiation dose was reduced by 66% for FTC70 at 100 kVp (mean radiation dose: 4.4 ± 0.9 mSv) and by 43% for FTC70 at 120 kVp. 99% of 780 segments in the FTC70 group were of diagnostic quality. Noise, signal-to-noise ratio, and contrast-to-noise ratio were comparable between FTC70 and FTC45-75 for both 100 and 120 kVp. BMI, CCS and maximal heart rate variation were predictors of image quality. Tube voltage, FTC window width, scan length, and average heart rate were predictors of radiation dose.

Conclusions

A successful patient-based algorithm for radiation dose reduction during helical CCTA using DSCT has been developed and validated in clinical practice.

Keywords: Algorithm for radiation dose reduction, Coronary computed tomography angiography, Dual-source computed tomography, Radiation dose, Low-kilovoltage, Tube current modulation

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 Conflict of interest: Ludovic Le Meunier is an employee of Siemens Medical Solutions, PET Division.

 Ariel Gutstein and Arik Wolak are cardiac imaging fellows supported by Save a Heart Foundation, Los Angeles, California; Ariel Gutstein was supported in part by a grant from the American Physician Fellowship, Boston.

 The study was supported in part by grant from the Lincy Foundation, Los Angeles, California, The Eisner Foundation, and Diane and Guilford Glazer.

PII: S1934-5925(08)00551-0

doi:10.1016/j.jcct.2008.07.003

Journal of Cardiovascular Computed Tomography
Volume 2, Issue 5 , Pages 311-322, September 2008

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