Kavitha M Chinnaiyan1, Abhay N Bilolikar2, Edward Walsh3, Daniel Wood3, Ann DePetris2, Ralph Gentry2, Judith Boura4, Suhny Abbara5, Mouaz Al-Mallah6, Kostaki Bis3, Gilbert Boswell6, Michael Gallagher7, Ing-Orn Arunakul8, Sandra Halliburton8, Jill Jacobs9, John Lesser10, U Joseph Schoepf11, Uma S Valeti12, Gilbert L Raff2. 1. Department of Cardiovascular Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA. Electronic address: kchinnaiyan@beaumont.edu. 2. Department of Cardiovascular Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA. 3. Department of Radiology, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA. 4. Department of Research Administration, William Beaumont Hospitals, 3601 W. 13 Mile Road, Royal Oak, MI, USA. 5. Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, MA, USA. 6. Department of Cardiac Imaging, King Abdul-Aziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia. 7. Department of Radiology, Naval Medical Center, San Diego, CA, USA. 8. Department of Cardiovascular Medicine, William Beaumont Hospital, Troy, MI, USA. 9. Division of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA. 10. Department of Radiology, New York University, New York, NY, USA. 11. Cardiac Imaging, Minneapolis Heart Institute, Minneapolis, MN, USA. 12. Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA; Department Radiology, Medical University of South Carolina, Charleston, SC, USA; University of Minnesota, Minneapolis, MN, USA.
Abstract
OBJECTIVES: To establish current radiation dose levels with contemporary scanners capable of prospectively triggered or high-pitch spiral scan modes to previous generation scanners among patients evaluated for coronary artery disease, pulmonary embolism, aortic disease, and "triple rule out" in a large population of patients at multiple centers. BACKGROUND: Previous small-scale studies with carefully controlled scan protocols report that CT scanners that facilitate prospectively triggered scanning and provide high-pitch spiral CT scan modes drastically lower radiation doses. However, diagnostic reference levels should be selected by medical bodies on the basis of large surveys of representative sites and reviewed at appropriate time intervals. METHODS: Scan data including dose and image quality parameters were collected retrospectively from 64 slice scanners (control) and prospectively after sites installed 128-slice dual-source scanners with high-pitch capability (study). Protocol selection was purposely not specified to survey "real world" results. Blinded quantitative image analysis was performed on every fifth scan. RESULTS: From April 2011 to March 2012, 2085 patients at 9 sites completed the study: 1051 coronary artery disease (509 control, 542 study), 528 pulmonary embolism (267 control, 261 study), 419 aortic disease (268 control, 151 study), and 87 triple rule out (53 control, 34 study). There was a significant reduction in median dose-length product (DLP) from 669 mGy ∙ cm (interquartile range [IQR]: 419-1026 mGy ∙ cm) in the control group to 260 mGy ∙ cm (IQR: 159-441 mGy ∙ cm) in the study group, a reduction by 61% (P < .0001) and was lower in all categories. No significant differences were noted in image quality. CONCLUSION: Use of advanced scanners facilitating prospectively triggered or high-pitch spiral scan modes results in marked dose reduction across a variety of cardiovascular studies, with no compromise in image quality. These findings may contribute to new target dose recommendations in societal guidelines.
OBJECTIVES: To establish current radiation dose levels with contemporary scanners capable of prospectively triggered or high-pitch spiral scan modes to previous generation scanners among patients evaluated for coronary artery disease, pulmonary embolism, aortic disease, and "triple rule out" in a large population of patients at multiple centers. BACKGROUND: Previous small-scale studies with carefully controlled scan protocols report that CT scanners that facilitate prospectively triggered scanning and provide high-pitch spiral CT scan modes drastically lower radiation doses. However, diagnostic reference levels should be selected by medical bodies on the basis of large surveys of representative sites and reviewed at appropriate time intervals. METHODS: Scan data including dose and image quality parameters were collected retrospectively from 64 slice scanners (control) and prospectively after sites installed 128-slice dual-source scanners with high-pitch capability (study). Protocol selection was purposely not specified to survey "real world" results. Blinded quantitative image analysis was performed on every fifth scan. RESULTS: From April 2011 to March 2012, 2085 patients at 9 sites completed the study: 1051 coronary artery disease (509 control, 542 study), 528 pulmonary embolism (267 control, 261 study), 419 aortic disease (268 control, 151 study), and 87 triple rule out (53 control, 34 study). There was a significant reduction in median dose-length product (DLP) from 669 mGy ∙ cm (interquartile range [IQR]: 419-1026 mGy ∙ cm) in the control group to 260 mGy ∙ cm (IQR: 159-441 mGy ∙ cm) in the study group, a reduction by 61% (P < .0001) and was lower in all categories. No significant differences were noted in image quality. CONCLUSION: Use of advanced scanners facilitating prospectively triggered or high-pitch spiral scan modes results in marked dose reduction across a variety of cardiovascular studies, with no compromise in image quality. These findings may contribute to new target dose recommendations in societal guidelines.
Authors: Thomas J Stocker; Simon Deseive; Marcus Chen; Jonathon Leipsic; Martin Hadamitzky; Ronen Rubinshtein; Erik L Grove; Xiang-Ming Fang; John Lesser; Pál Maurovich-Horvat; Hugo Marques; Daniele Andreini; Ramzi Tabbalat; Joon-Won Kang; Joachim Eckert; Patricia Dickson; Signe H Forsdahl; Jess Lambrechtsen; Roberto C Cury; Jörg Hausleiter Journal: J Cardiovasc Comput Tomogr Date: 2017-12-05