Focused, low tube potential, coronary calcium assessment prior to coronary CT angiography: A prospective, randomized clinical trial

Crimm, Hampton A.; Fergestrom, Nicole; Dye, Cicely; Philip, Cynthia; Nguyen, Binh; Villines, Todd C.

doi:10.1016/j.jcct.2020.08.011

Cited by 3 publications

(2 citation statements)

References 20 publications

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“…It is outside the scope of our examination to determine whether the RSL CAC score as a stand-alone value is predictive of acute coronary syndrome events. Finally, this study was a retrospective examination aimed primarily at hypothesis generation; however, our results were prospectively corroborated in a recently published prospective clinical trial—the Focused field of view calcium scoring prior to coronary CT angiography (FOCUS-CCTA; ClinicalTrials.gov Identifier: NCT02972242) ( 17 ).…”

Section: Discussionmentioning

confidence: 67%

Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography

et al. 2020

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Extensive coronary artery calcium (CAC) diminishes the accuracy of coronary computed tomography angiography (CCTA). Many imagers adjust CCTA acquisition parameters depending on a preCCTA Agatston CAC score to optimize diagnostic accuracy. Typical preCCTA CAC imaging adds considerably to radiation exposure, partially attributable to imaging beyond the area known for highest CAC, the proximal coronary arteries. We aimed to determine whether a z -axis reduced scan length (RSL) would identify the majority of CAC and provide adequate information to computed tomography angiography providers relative to a standard full-scan length (FSL) preCCTA noncontrast CT. We retrospectively examined 200 subjects. The mean CAC scores detected in RSL and FSL were 77.4 (95% CI 50.6 to 104.3) and 93.9 (95% CI 57.3 to 130.5), respectively. RSL detected 81% of the FSL CAC. Among false negatives, with no CAC detected in RSL, FSL CAC severity was minimal (mean score 2.8). There was high concordance, averaging 88%, between CCTA imaging parameter adjustment decisions made by 2 experienced imagers based on either RSL or FSL. CAC detected and decision concordance decreased with increasing CAC burden. CAC detected was lower, and false negatives were more common in the right coronary artery owing to its anatomic course, placing larger segments outside RSL. Axial scan length and effective dose decreased 59% from FSL (∼14.5 cm/∼1.1 mSv) to RSL (∼5.9 cm/∼0.45 mSv). This retrospective study suggests that RSL identifies most CAC, results in similar CCTA acquisition parameter modifications, and reduces radiation exposure. Our colleagues corroborated these results in a recently published prospective study.

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Section: Discussionmentioning

confidence: 67%

Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography

et al. 2020

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“… 26 The artefact may be reduced by changing the acquisition parameters, such as kVp, padding and choice of prospective/retrospective gating. 27 …”

Section: Discussionmentioning

confidence: 99%

Impact of an ultra-low dose unenhanced planning scan on CT coronary angiography scan length and effective radiation dose

et al. 2022

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Objective Imaged scan length (z-axis coverage) is a simple parameter that can reduce CT dose without compromising image quality. In CT coronary angiography (CTCA), z-axis coverage may be planned using non-contrast calcium score scan (CaCS) to identify the relevant coronary anatomy. However, standardised Agatston CaCS is acquired at 120 kV which adds a relatively high contribution to total study dose and CaCS is no longer routinely recommended in UK guidelines. We evaluate an ultra-low dose unenhanced planning scan on CTCA scan length and effective radiation dose. Methods: An ultra-low dose tin filter (Sn-filter) planning scan (100 kVp, maximum iterative reconstruction) was performed and used to plan the z-axis coverage on 48 consecutive CTCAs (62% men, 62 ± 13 years) compared with 47 CTCA planned using a localiser alone (46% men, 59 ± 12 years) between May and June 2019. Excess scanning beyond the ideal scan length was calculated for both groups. Estimations of radiation dose were also compared between the two groups. Results: Addition of an ultra-low dose unenhanced planning scan to CTCA protocol was associated with reduction in overscanning with no impact on image quality. There was no significant difference in total study effective dose with the addition of the planning scan, which had an average dose–length product of 3 mGy.cm. (total study dose: Protocol A 2.1 mSv vs Protocol B 2.2 mSv, p = 0.92). Conclusion: An ultra-low dose unenhanced planning scan facilitates optimal scan length for the diagnostic CTCA, reducing overscanning and preventing incomplete cardiac imaging with no significant dose penalty or impact on image quality. Advances in knowledge: An ultra-low dose CTCA planning is feasible and effective at optimising scan length.

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Reduction in radiation exposure using a focused low-voltage scan before coronary CT angiography

Al’Aref

2021

Journal of Cardiovascular Computed Tomography

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Focused, low tube potential, coronary calcium assessment prior to coronary CT angiography: A prospective, randomized clinical trial

Cited by 3 publications

References 20 publications

Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography

Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography

Impact of an ultra-low dose unenhanced planning scan on CT coronary angiography scan length and effective radiation dose

Reduction in radiation exposure using a focused low-voltage scan before coronary CT angiography

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