Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of a Chest Circumference-Adapted Protocol for Low-Dose 128-Slice Coronary CT Angiography with Prospective Electrocardiogram Triggering

  • Lu, Chenying (Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College) ;
  • Wang, Zufei (Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College) ;
  • Ji, Jiansong (Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College) ;
  • Wang, Hailin (Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College) ;
  • Hu, Xianghua (Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College) ;
  • Chen, Chunmiao (Department of Radiology, Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College)
  • Received : 2014.07.15
  • Accepted : 2014.11.10
  • Published : 2015.02.01
⟨ Previous Next ⟩

Abstract

Objective: To assess the effect of chest circumference-adapted scanning protocol on radiation exposure and image quality in patients undergoing prospective electrocardiogram (ECG)-triggered coronary CT angiography (CCTA). Materials and Methods: One hundred-eighty-five consecutive patients, who had undergone prospective ECG triggering CCTA with a 128-slice CT, were included in the present study. Nipple-level chest circumference, body weight and height were measured before CT examinations. Patients were divided into four groups based on $kV/ref{\cdot}mAs$ = 100/200, 100/250, 120/200, and 120/250, when patient's chest circumference was ${\leq}85.0$ (n = 56), 85.0-90.0 (n = 53), 90.0-95.0 (n = 44), and > 95.0 (n = 32), respectively. Image quality per-segment was independently assessed by two experienced observers. Image noise and attenuation were also measured. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. The effective radiation dose was calculated using CT dose volume index and the dose-length product. Results: A significant correlation was observed between patients' chest circumference and body mass index (r = 0.762, p < 0.001). Chest circumference ranged from 74 to 105 cm, and the mean effective radiation dose was 1.9-3.8 mSv. Diagnostic image quality was obtained in 98.5% (2440/2478) of all evaluated coronary segments without any significant differences among the four groups (p = 0.650). No significant difference in image noise was observed among the four groups (p = 0.439), thus supporting the validity of the chest circumference-adapted scanning protocol. However, vessel attenuation, SNR and CNR were significantly higher in the 100 kV groups than in the 120 kV groups (p < 0.05). Conclusion: A measure of chest circumference can be used to adapt tube voltage and current for individualized radiation dose control, with resultant similar image noise and sustained diagnostic image quality.

Keywords

References

  1. Motoyama S, Anno H, Sarai M, Sato T, Sanda Y, Ozaki Y, et al. Noninvasive coronary angiography with a prototype 256-row area detector computed tomography system: comparison with conventional invasive coronary angiography. J Am Coll Cardiol 2008;51:773-775 https://doi.org/10.1016/j.jacc.2007.09.062
  2. Miller JM, Rochitte CE, Dewey M, Arbab-Zadeh A, Niinuma H, Gottlieb I, et al. Diagnostic performance of coronary angiography by 64-row CT. N Engl J Med 2008;359:2324-2336 https://doi.org/10.1056/NEJMoa0806576
  3. Rybicki FJ, Otero HJ, Steigner ML, Vorobiof G, Nallamshetty L, Mitsouras D, et al. Initial evaluation of coronary images from 320-detector row computed tomography. Int J Cardiovasc Imaging 2008;24:535-546 https://doi.org/10.1007/s10554-008-9308-2
  4. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 2007;298:317-323 https://doi.org/10.1001/jama.298.3.317
  5. Hausleiter J, Meyer T, Hermann F, Hadamitzky M, Krebs M, Gerber TC, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA 2009;301:500-507 https://doi.org/10.1001/jama.2009.54
  6. Achenbach S, Goroll T, Seltmann M, Pflederer T, Anders K, Ropers D, et al. Detection of coronary artery stenoses by lowdose, prospectively ECG-triggered, high-pitch spiral coronary CT angiography. JACC Cardiovasc Imaging 2011;4:328-337 https://doi.org/10.1016/j.jcmg.2011.01.012
  7. Hong YJ, Kim SJ, Lee SM, Min PK, Yoon YW, Lee BK, et al. Low-dose coronary computed tomography angiography using prospective ECG-triggering compared to invasive coronary angiography. Int J Cardiovasc Imaging 2011;27:425-431 https://doi.org/10.1007/s10554-010-9674-4
  8. Hosch W, Heye T, Schulz F, Lehrke S, Schlieter M, Giannitsis E, et al. Image quality and radiation dose in 256-slice cardiac computed tomography: comparison of prospective versus retrospective image acquisition protocols. Eur J Radiol 2011;80:127-135 https://doi.org/10.1016/j.ejrad.2010.07.011
  9. Herzog BA, Husmann L, Valenta I, Tay FM, Burkhard N, Gaemperli O, et al. Determinants of vessel contrast in BMIadapted low dose CT coronary angiography with prospective ECG-triggering. Int J Cardiovasc Imaging 2009;25:625-630 https://doi.org/10.1007/s10554-009-9460-3
  10. Hosch W, Stiller W, Mueller D, Gitsioudis G, Welzel J, Dadrich M, et al. Reduction of radiation exposure and improvement of image quality with BMI-adapted prospective cardiac computed tomography and iterative reconstruction. Eur J Radiol 2012;81:3568-3576 https://doi.org/10.1016/j.ejrad.2011.06.055
  11. Ghoshhajra BB, Engel LC, Major GP, Verdini D, Sidhu M, Karolyi M, et al. Direct chest area measurement: a potential anthropometric replacement for BMI to inform cardiac CT dose parameters? J Cardiovasc Comput Tomogr 2011;5:240-246 https://doi.org/10.1016/j.jcct.2011.06.003
  12. Valentin J; International Commission on Radiation Protection. Managing patient dose in multi-detector computed tomography (MDCT). ICRP Publication 102. Ann ICRP 2007;37:1-79, iii
  13. Austen WG, Edwards JE, Frye RL, Gensini GG, Gott VL, Griffith LS, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975;51(4 Suppl):5-40 https://doi.org/10.1161/01.CIR.51.4.5
  14. Matsubara K, Koshida K, Suzuki M, Shimono T, Yamamoto T, Matsui O. Effective dose evaluation of multidetector CT examinations: influence of the ICRP recommendation in 2007. Eur Radiol 2009;19:2855-2861 https://doi.org/10.1007/s00330-009-1497-0
  15. Neefjes LA, Dharampal AS, Rossi A, Nieman K, Weustink AC, Dijkshoorn ML, et al. Image quality and radiation exposure using different low-dose scan protocols in dual-source CT coronary angiography: randomized study. Radiology 2011;261:779-786 https://doi.org/10.1148/radiol.11110606
  16. Hoang JK, Hurwitz LM, Boll DT. Optimization of tube current in coronary multidetector computed tomography angiography: assessment of a standardized method to individualize current selection based on body habitus. J Comput Assist Tomogr 2009;33:498-504 https://doi.org/10.1097/RCT.0b013e31818af37c
  17. Bischoff B, Hein F, Meyer T, Hadamitzky M, Martinoff S, Schomig A, et al. Impact of a reduced tube voltage on CT angiography and radiation dose: results of the PROTECTION I study. JACC Cardiovasc Imaging 2009;2:940-946 https://doi.org/10.1016/j.jcmg.2009.02.015
  18. Feuchtner GM, Jodocy D, Klauser A, Haberfellner B, Aglan I, Spoeck A, et al. Radiation dose reduction by using 100-kV tube voltage in cardiac 64-slice computed tomography: a comparative study. Eur J Radiol 2010;75:e51-e56 https://doi.org/10.1016/j.ejrad.2009.07.012
  19. Leipsic J, Labounty TM, Heilbron B, Min JK, Mancini GB, Lin FY, et al. Estimated radiation dose reduction using adaptive statistical iterative reconstruction in coronary CT angiography: the ERASIR study. AJR Am J Roentgenol 2010;195:655-660 https://doi.org/10.2214/AJR.10.4288
  20. Menke J. Comparison of different body size parameters for individual dose adaptation in body CT of adults. Radiology 2005;236:565-571 https://doi.org/10.1148/radiol.2362041327
  21. Leschka S, Stolzmann P, Schmid FT, Scheffel H, Stinn B, Marincek B, et al. Low kilovoltage cardiac dual-source CT: attenuation, noise, and radiation dose. Eur Radiol 2008;18:1809-1817 https://doi.org/10.1007/s00330-008-0966-1
  22. Pflederer T, Rudofsky L, Ropers D, Bachmann S, Marwan M, Daniel WG, et al. Image quality in a low radiation exposure protocol for retrospectively ECG-gated coronary CT angiography. AJR Am J Roentgenol 2009;192:1045-1050 https://doi.org/10.2214/AJR.08.1025
  23. Nakayama Y, Awai K, Funama Y, Hatemura M, Imuta M, Nakaura T, et al. Abdominal CT with low tube voltage: preliminary observations about radiation dose, contrast enhancement, image quality, and noise. Radiology 2005;237:945-951 https://doi.org/10.1148/radiol.2373041655

Cited by

  1. High-Pitch Coronary CT Angiography at 70 kVp Adopting a Protocol of Low Injection Speed and Low Volume of Contrast Medium vol.18, pp.5, 2017, https://doi.org/10.3348/kjr.2017.18.5.763
  2. EVALUATION OF RADIATION ABSORBED DOSE AND IMAGE QUALITY IN DIFFERENT RETROSPECTIVE-ECG GATING ACQUISITION METHODS OF CARDIAC CT ANGIOGRAPHY vol.178, pp.3, 2015, https://doi.org/10.1093/rpd/ncx111
  3. Automatic tube potential selection with tube current modulation in coronary CT angiography: Can it achieve consistent image quality among various individuals? vol.16, pp.1, 2015, https://doi.org/10.3892/etm.2018.6158