Image Quality and Feasibility of an Ultralow-dose High-pitch Helical Triple–rule-out Computed Tomography Angiography Acquired in the Caudocranial Direction

Kligerman, Seth; White, Charles S.

doi:10.1097/rti.0000000000000059

Cited by 13 publications

(6 citation statements)

References 27 publications

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“…A second study compared more than 2000 patients evaluated with TRO CT or dedicated coronary CTA and found median effective radiation doses of 12.0 ± 5.6 mSv and 8.2 ± 4.0 mSv, respectively [11]. These concerns are becoming less important as modern scanners become faster and require less IV contrast agent and as new dose-saving techniques provide further reductions in the effective radiation dose [22,23].…”

Section: Triple-rule-out Ct For Evaluation Of Chest Pain In Emergencymentioning

confidence: 99%

Diagnostic Yield of Triple-Rule-Out CT in an Emergency Setting

Wnorowski

Halpern

2016

American Journal of Roentgenology

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Section: Triple-rule-out Ct For Evaluation Of Chest Pain In Emergencymentioning

confidence: 99%

Diagnostic Yield of Triple-Rule-Out CT in an Emergency Setting

Wnorowski

Halpern

2016

American Journal of Roentgenology

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“…There exist already some in vivo and ex vivo studies that evaluated the potential of HPM for compensation of motion artifacts with positive results (18)(19)(20)(21)(22). Baumueller et al (22) investigated whether HPM for CT enables the diagnostic visualization of lung parenchyma under breathing and found that CT of the lung can be accomplished using HPM at low radiation dose, with maintaining diagnostic image quality even without suspended respiration.…”

Section: Discussionmentioning

confidence: 99%

“…Baumueller et al (22) investigated whether HPM for CT enables the diagnostic visualization of lung parenchyma under breathing and found that CT of the lung can be accomplished using HPM at low radiation dose, with maintaining diagnostic image quality even without suspended respiration. Other authors (10,18,19) evaluated HPM for the feasibility in coronary CT angiography and found that CT performed at HPM allows for coronary angiography with high pitch up to 70 bpm. In the above-listed studies, image acquisition was performed ECGgated and did not test HPM for the detection of PE protocols.…”

Section: Discussionmentioning

confidence: 99%

Prospective Randomized Comparison of High-pitch CT at 80 kVp Under Free Breathing with Standard-pitch CT at 100 kVp Under Breath-Hold for Detection of Pulmonary Embolism

et al. 2016

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RATIONALE AND OBJECTIVES To prospectively compare high-pitch computed tomography (HPCT) under free breathing (FB) with standard-pitch CT (SPCT) under breath-hold (BH) for detection of pulmonary embolism (PE). MATERIALS AND METHODS One hundred consecutive patients (47 females; mean age 58.7 ± 16.6) randomly underwent HPCT-FB (n = 50) or SPCT-BH (n = 50). Radiation doses were documented. One reader measured pulmonary artery attenuation and noise; mean signal-tonoise ratio (SNR) was calculated. Two readers assessed image quality, diagnostic confidence for detection of PE, motion artifacts, assessability of anatomical structures, and presence of transient interruption of contrast as sign of Valsalva maneuver. Inter-reader agreement was calculated. RESULTS Radiation dose was significantly lower in HPCT compared to SPCT (2.68 ± 0.60 mGy vs 6.01 ± 2.26 mGy; P < .001). Mean pulmonary artery attenuation and image noise were significantly higher in HPCT (attenuation: 479 Hounsfield unit (HU) vs 343HU; P < .001; noise: 16 HU vs 10 HU; P < .001) whereas SNR was similar between groups (34 HU vs 38 HU; P = .258). HPCT had significantly higher diagnostic confidence for PE detection (P = .048), less cardiac and breathing artifacts (P < .001), better assessability of anatomical structures, and fewer cases of transient interruption of contrast (P < .001) compared to the SPCT. CONCLUSIONS HPCT-FB allows for a significant reduction of breathing and motion artifacts compared to SPCT-BH. Diagnostic confidence, assessability of vascular and bronchial structures, as well as SNR are maintained. Materials and Methods:One hundred consecutive patients (47 females; mean age 58.7 ± 16.6) randomly underwent HPCT-FB (n = 50) or SPCT-BH (n = 50). Radiation doses were documented. One reader measured pulmonary artery attenuation and noise; mean signalto-noise ratio (SNR) was calculated. Two readers assessed image quality, diagnostic confidence for detection of PE, motion artifacts, assessability of anatomical structures, and presence of transient interruption of contrast as sign of Valsalva maneuver. Inter-reader agreement was calculated.Results: Radiation dose was significantly lower in HPCT compared to SPCT (2.68 ± 0.60 mGy vs 6.01 ± 2.26 mGy; P < .001). Mean pulmonary artery attenuation and image noise were significantly higher in HPCT (attenuation: 479 Hounsfield unit (HU) vs 343HU; P < .001; noise: 16 HU vs 10 HU; P < .001) whereas SNR was similar between groups (34 HU vs 38 HU; P = .258). HPCT had significantly higher diagnostic confidence for PE detection (P = .048), less cardiac and breathing artifacts (P < .001), better assessability of anatomical structures, and fewer cases of transient interruption of contrast (P < .001) compared to the SPCT.Conclusions: HPCT-FB allows for a significant reduction of breathing and motion artifacts compared to SPCT-BH. Diagnostic confidence, assessability of vascular and bronchial structures, as well as SNR are maintained.

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“…ECG-gated computed tomography angiography (CTA) of the chest has been shown to be a reliable and comprehensive non-invasive imaging test to exclude acute coronary syndrome, aortic dissection and pulmonary embolism in patients presenting to the emergency department with acute chest pain (i.e., Triple Rule Out (TRO)-CTA) [1–9]. …”

Section: Introductionmentioning

confidence: 99%

Low-tube-voltage selection for triple-rule-out CTA: relation to patient size

et al. 2016

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ObjectivesTo investigate the relationship between image quality and patient size at 100 kilovoltage (kV) compared to 120 kV ECG-gated Triple-Rule-Out CT angiography (TRO-CTA).MethodsWe retrospectively included 73 patients (age 64 ± 14 years) who underwent retrospective ECG-gated chest CTA. 40 patients were scanned with 100 kV while 33 patients with 120 kV. Body mass index (BMI), patients’ chest circumference (PC) and thoracic surface area (TSA) were recorded. Quantitative image quality was assessed as vascular attenuation in the ascending aorta (AA), pulmonary trunk (PA) and left coronary artery (LCA) and the signal-to-noise ratio (SNR) in the AA.ResultsThere was no significant difference in BMI (26.0 ± 4.6 vs. 28.0 ± 6.7 kg/m2), PC (103 ± 7 vs. 104 ± 10 cm2) and TSA (92 ± 15 vs. 91 ± 19 cm2) between 100 kV and 120 kV group. Mean vascular attenuation was significantly higher in the 100 kV compared to the 120 kV group (AA 438 vs. 354 HU, PA 460 vs. 349 HU, LCA 370 vs. 299 HU all p < 0.001). SNR was not significantly different, even after adjusting for patient size. Radiation dose was significantly lower in the 100 kV group (10.7 ± 4.1 vs. 20.7 ± 10.7 mSv; p < 0.001).Conclusions100 kV TRO-CTA is feasible in normal-to-overweight patients while maintaining image quality and achieving substantial dose reduction.Key Points• 100 kV protocols result in a significantly lower radiation dose. • Mean vascular attenuation is significantly higher using 100 kV. • SNR and CNR are not significantly different between 100 kV and 120 kV. • 100 kV CTA is feasible regardless of patient size while maintaining image quality.

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Image Quality and Feasibility of an Ultralow-dose High-pitch Helical Triple–rule-out Computed Tomography Angiography Acquired in the Caudocranial Direction

Abstract: Low-dose, high-image quality TRO scans can be effectively performed using a high-pitch helical acquisition.

Cited by 13 publications

References 27 publications

Diagnostic Yield of Triple-Rule-Out CT in an Emergency Setting

Diagnostic Yield of Triple-Rule-Out CT in an Emergency Setting

Prospective Randomized Comparison of High-pitch CT at 80 kVp Under Free Breathing with Standard-pitch CT at 100 kVp Under Breath-Hold for Detection of Pulmonary Embolism

Low-tube-voltage selection for triple-rule-out CTA: relation to patient size

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