Korean Journal of Radiology

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

DOI QR Code

Tube Voltage, DNA Double-Strand Breaks, and Image Quality in Coronary CT Angiography

  • Zhu Xiao Lin (Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University) ;
  • Fan Zhou (Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University) ;
  • U. Joseph Schoepf (Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University) ;
  • Balakrishnan Pillai (Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina) ;
  • Chang Sheng Zhou (Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University) ;
  • Wei Quan (Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University) ;
  • Xue Qin Bao (Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University) ;
  • Guang Ming Lu (Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University) ;
  • Long Jiang Zhang (Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University)
  • Received : 2019.12.24
  • Accepted : 2020.03.05
  • Published : 2020.08.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective: To evaluate the effects of tube voltage on image quality in coronary CT angiography (CCTA), the estimated radiation dose, and DNA double-strand breaks (DSBs) in peripheral blood lymphocytes to optimize the use of CCTA in the era of low radiation doses. Materials and Methods: This study included 240 patients who were divided into 2 groups according to the DNA DSB analysis methods, i.e., immunofluorescence microscopy and flow cytometry. Each group was subdivided into 4 subgroups: those receiving CCTA only with different tube voltages of 120, 100, 80, or 70 kVp. Objective and subjective image quality was evaluated by analysis of variance. Radiation dosages were also recorded and compared. Results: There was no significant difference in demographic characteristics between the 2 groups and 4 subgroups in each group (all p > 0.05). As tube voltage decreased, both image quality and radiation dose decreased gradually and significantly. After CCTA, γ-H2AX foci and mean fluorescence intensity in the 120-, 100-, 80-, and 70-kVp groups increased by 0.14, 0.09, 0.07, and 0.06 foci per cell and 21.26, 9.13, 8.10, and 7.13 (all p < 0.05), respectively. The increase in the DNA DSB level in the 120-kVp group was higher than those in the other 3 groups (all p < 0.05), while there was no significant difference in the DSBs levels among these latter groups (all p > 0.05). Conclusion: The 100-kVp tube voltage may be optimal for CCTA when weighing DNA DSBs against the estimated radiation dose and image quality, with further reductions in tube voltage being unnecessary for CCTA.

Keywords

Acknowledgement

This work was supported by The National Key Research and Development Program of China (2017YFC0113400 for L.J.Z.).

References

  1. Mark DB, Berman DS, Budoff MJ, Carr JJ, Gerber TC, Hecht HS, et al. ACCF/ACR/AHA/NASCI/SAIP/SCAI/SCCT 2010 expert consensus document on coronary computed tomographic angiography: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010;55:2663-2699  https://doi.org/10.1016/j.jacc.2009.11.013
  2. Bloomfield GS, Gillam LD, Hahn RT, Kapadia S, Leipsic J, Lerakis S, et al. A practical guide to multimodality imaging of transcatheter aortic valve replacement. JACC Cardiovasc Imaging 2012;5:441-455  https://doi.org/10.1016/j.jcmg.2011.12.013
  3. Martinez MW, Kirsch J, Williamson EE, Syed IS, Feng D, Ommen S, et al. Utility of nongated multidetector computed tomography for detection of left atrial thrombus in patients undergoing catheter ablation of atrial fibrillation. JACC Cardiovasc Imaging 2009;2:69-76  https://doi.org/10.1016/j.jcmg.2008.09.011
  4. Caruso D, De Santis D, Biondi T, Panvini N, Zerunian M, Rivosecchi F, et al. Half-dose coronary artery calcium scoring: impact of iterative reconstruction. J Thorac Imaging 2019;34:18-25  https://doi.org/10.1097/RTI.0000000000000340
  5. Tabari A, Lo Gullo R, Murugan V, Otrakji A, Digumarthy S, Kalra M. Recent advances in computed tomographic technology: cardiopulmonary imaging applications. J Thorac Imaging 2017;32:89-100  https://doi.org/10.1097/RTI.0000000000000258
  6. Pontone G, Muscogiuri G, Baggiano A, Andreini D, Guaricci AI, Guglielmo M, et al. Image quality, overall evaluability, and effective radiation dose of coronary computed tomography angiography with prospective electrocardiographic triggering plus intracycle motion correction algorithm in patients with a heart rate over 65 beats per minute. J Thorac Imaging 2018;33:225-231  https://doi.org/10.1097/RTI.0000000000000320
  7. Zhang LJ, Qi L, Wang J, Tang CX, Zhou CS, Ji XM, et al. Feasibility of prospectively ECG-triggered high-pitch coronary CT angiography with 30 mL iodinated contrast agent at 70 kVp: initial experience. Eur Radiol 2014;24:1537-1546  https://doi.org/10.1007/s00330-014-3157-2
  8. Spearman JV, Schoepf UJ, Rottenkolber M, Driesser I, Canstein C, Thierfelder KM, et al. Effect of automated attenuation-based tube voltage selection on radiation dose at CT: an observational study on a global scale. Radiology 2016;279:167-174  https://doi.org/10.1148/radiol.2015141507
  9. Mangold S, Wichmann JL, Schoepf UJ, Poole ZB, Canstein C, Varga-Szemes A, et al. Automated tube voltage selection for radiation dose and contrast medium reduction at coronary CT angiography using 3(rd) generation dual-source CT. Eur Radiol 2016;26:3608-3616  https://doi.org/10.1007/s00330-015-4191-4
  10. Zhang LJ, Wang Y, Schoepf UJ, Meinel FG, Bayer RR 2nd, Qi L, et al. Image quality, radiation dose, and diagnostic accuracy of prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp in a clinical setting: comparison with invasive coronary angiography. Eur Radiol 2016;26:797-806  https://doi.org/10.1007/s00330-015-3868-z
  11. Kuefner MA, Brand M, Ehrlich J, Braga L, Uder M, Semelka RC. Effect of antioxidants on X-ray-induced γ-H2AX foci in human blood lymphocytes: preliminary observations. Radiology 2012;264:59-67  https://doi.org/10.1148/radiol.12111730
  12. Cadet J, Douki T, Ravanat JL. Oxidatively generated base damage to cellular DNA. Free Radic Biol Med 2010;49:9-21  https://doi.org/10.1016/j.freeradbiomed.2010.03.025
  13. Corre I, Niaudet C, Paris F. Plasma membrane signaling induced by ionizing radiation. Mutat Res 2010;704:61-67  https://doi.org/10.1016/j.mrrev.2010.01.014
  14. Haro KJ, Sheth A, Scheinberg DA. Dysregulation of IRP1-mediated iron metabolism causes gamma ray-specific radioresistance in leukemia cells. PLoS One 2012;7:e48841 
  15. de Gonzalez AB, Darby S. Risk of cancer from diagnostic X-rays: estimates for the UK and 14 other countries. Lancet 2004;363:345-351  https://doi.org/10.1016/S0140-6736(04)15433-0
  16. Fiechter M, Stehli J, Fuchs TA, Dougoud S, Gaemperli O, Kaufmann PA. Impact of cardiac magnetic resonance imaging on human lymphocyte DNA integrity. Eur Heart J 2013;34:2340-2345  https://doi.org/10.1093/eurheartj/eht184
  17. Muslimovic A, Ismail IH, Gao Y, Hammarsten O. An optimized method for measurement of gamma-H2AX in blood mononuclear and cultured cells. Nat Protoc 2008;3:1187-1193  https://doi.org/10.1038/nprot.2008.93
  18. Johansson P, Fasth A, Ek T, Hammarsten O. Validation of a flow cytometry-based detection of γ-H2AX, to measure DNA damage for clinical applications. Cytometry B Clin Cytom 2017;92:534-540  https://doi.org/10.1002/cyto.b.21374
  19. Nguyen PK, Lee WH, Li YF, Hong WX, Hu S, Chan C, et al. Assessment of the radiation effects of cardiac CT angiography using protein and genetic biomarkers. JACC Cardiovasc Imaging 2015;8:873-884  https://doi.org/10.1016/j.jcmg.2015.04.016
  20. Kuefner MA, Grudzenski S, Hamann J, Achenbach S, Lell M, Anders K, et al. Effect of CT scan protocols on x-ray-induced DNA double-strand breaks in blood lymphocytes of patients undergoing coronary CT angiography. Eur Radiol 2010;20:2917-2924  https://doi.org/10.1007/s00330-010-1873-9
  21. Zhang B, Gong JP, Zhang W, Pan SW. Influence of tube voltage in CT-induced DNA double-strand breaks in human peripheral blood lymphocytes. Chin J Nucl Med Mol Imaging 2016;36:466-467 
  22. Halliburton SS, Abbara S, Chen MY, Gentry R, Mahesh M, Raff GL, et al. SCCT guidelines on radiation dose and dose-optimization strategies in cardiovascular CT. J Cardiovasc Comput Tomogr 2011;5:198-224  https://doi.org/10.1016/j.jcct.2011.06.001
  23. Wu Q, Wang Y, Kai H, Wang T, Tang X, Wang X, et al. Application of 80-kVp tube voltage, low-concentration contrast agent and iterative reconstruction in coronary CT angiography: evaluation of image quality and radiation dose. Int J Clin Pract 2016;70 Suppl 9B:B50-B55  https://doi.org/10.1111/ijcp.12852
  24. Zhang LJ, Qi L, De Cecco CN, Zhou CS, Spearman JV, Schoepf UJ, et al. High-pitch coronary CT angiography at 70 kVp with low contrast medium volume: comparison of 80 and 100 kVp high-pitch protocols. Medicine (Baltimore) 2014;93:e92 
  25. Wang W, Zhao YE, Qi L, Li X, Zhou CS, Zhang LJ, et al. Prospectively ECG-triggered high-pitch coronary CT angiography at 70 kVp with 30mL contrast agent: an intraindividual comparison with sequential scanning at 120 kVp with 60mL contrast agent. Eur J Radiol 2017;90:97-105  https://doi.org/10.1016/j.ejrad.2017.02.020
  26. Ebersberger U, Tricarico F, Schoepf UJ, Blanke P, Spears JR, Rowe GW, et al. CT evaluation of coronary artery stents with iterative image reconstruction: improvements in image quality and potential for radiation dose reduction. Eur Radiol 2013;23:125-132  https://doi.org/10.1007/s00330-012-2580-5
  27. Beels L, Bacher K, Smeets P, Verstraete K, Vral A, Thierens H. Dose-length product of scanners correlates with DNA damage in patients undergoing contrast CT. Eur J Radiol 2012;81:1495-1499  https://doi.org/10.1016/j.ejrad.2011.04.063
  28. Lobrich M, Rief N, Kuhne M, Heckmann M, Fleckenstein J, Rube C, et al. In vivo formation and repair of DNA double-strand breaks after computed tomography examinations. Proc Natl Acad Sci U S A 2005;102:8984-8989  https://doi.org/10.1073/pnas.0501895102
  29. Brand M, Sommer M, Achenbach S, Anders K, Lell M, Lobrich M, et al. X-ray induced DNA double-strand breaks in coronary CT angiography: comparison of sequential, low-pitch helical and high-pitch helical data acquisition. Eur J Radiol 2012;81:e357-e362  https://doi.org/10.1016/j.ejrad.2011.11.027
  30. Lee SM, Lee W, Chung JW, Park EA, Park JH. Effect of kVp on image quality and accuracy in coronary CT angiography according to patient body size: a phantom study. Int J Cardiovasc Imaging 2013;29 Suppl 2:83-91 https://doi.org/10.1007/s10554-013-0298-3