Maximizing the clinical benefit of high-pitch, single-heartbeat CT coronary angiography in clinical practice

Noble, Victoria St; Douraghi-Zadeh, Dariush; Padley, Simon; Rubens, Michael B.; Nicol, Edward

doi:10.1016/j.crad.2014.01.013

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…If attempted outside these parameters the chance of artefact increases significantly (Fig 3). 25 Good radiographic practice…”

Section: Vignette 3 Completing the Audit Cyclementioning

confidence: 99%

“…Publication is designed to ensure we make our findings available to the whole CCT community. The departmental audit programme has led to publications in the areas of dual-energy CT, 33 the optimal use of high-pitch acquisition, 25 the effect of incidental findings in CT on outcome, 34 imaging optimisation in atrial fibrillation, 35 calcium scoring from CTCA datasets, 36,37 and high versus standard pitch acquisition in clinical practice. 38 In addition to sharing our findings we have achieved both wider benefit to the trainee in publishing but also a deeper cultural understanding of how audit, over time and following multiple cycles, clearly can deliver real-world improvement and prove a valuable tool in supporting a QA culture.…”

Section: Referral Reporting and Reviewmentioning

confidence: 99%

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Quality assurance in cardiovascular CT: a practical guide

et al. 2016

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Cardiovascular computed tomography (CCT) is a cutting-edge imaging technique providing important, non-invasive, diagnostic information. Concerns exist regarding radiation exposure to patient populations, but achieving optimal image quality at the lowest doses can be challenging. This guide provides practical advice about how quality can be assured in any CCT unit or radiology department. Illustrated by real-world vignettes and data analysis from our own experience, we highlight a multidisciplinary team approach to each stage of the patient journey, the effectiveness of regular dose audit overseen by a CT optimisation group, and the importance of underused systolic scanning techniques, in order to drive significant dose reduction without loss of image quality or clinical confidence.

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“…If attempted outside these parameters the chance of artefact increases significantly (Fig 3). 25 Good radiographic practice…”

Section: Vignette 3 Completing the Audit Cyclementioning

confidence: 99%

Section: Referral Reporting and Reviewmentioning

confidence: 99%

Quality assurance in cardiovascular CT: a practical guide

et al. 2016

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“…The median heart rate for patients in both groups was ~70 beats/min, significantly higher than the regular 60 beats/min or less normally desirable for coronary CT-angiography. 10 This reflects the fact that with a limited aortic valve area, and therefore stroke volume, such patients maintain their cardiac output by augmenting their resting heart rate. It is likely that this had a greater impact on the frequency of diagnostic scans than the choice of protocol.…”

Section: Discussionmentioning

confidence: 99%

“… 3 6 However, patients being considered for TAVI often have significant coronary artery disease, which may impact on outcomes, 9 and can also potentially be simultaneously assessed by CTCA. High-pitch, dual-source protocols are increasingly being used in CTCA to minimise radiation dose 10 11 and iodine-based contrast medium load, but it is unclear whether they perform as well as standard-pitch prospective or retrospective ECG-gated protocols for aortic and coronary evaluation in this cohort. We compared diagnostic image quality with respect to the aorta and coronary arteries obtained using a single-acquisition, high-pitch combined whole-body angiogram and gated CT-aortogram/CT-coronary angiogram protocol against a conventional protocol with standard pitches involving a separate non-ECG-gated CT whole-body angiogram and an ECG-gated CT-aortogram/coronary angiogram in patients being considered for TAVI.…”

Section: Introductionmentioning

confidence: 98%

High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: a real-world appraisal

et al. 2017

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ObjectiveHigh-pitch protocols are increasingly used in cardiovascular CT assessment for transcatheter aortic valve implantation (TAVI), but the impact on diagnostic image quality is not known.MethodsWe reviewed 95 consecutive TAVI studies: 44 (46%) high-pitch and 51 (54%) standard-pitch. Single high-pitch scans were performed regardless of heart rate. For standard-pitch acquisitions, a separate CT-aortogram and CT-coronary angiogram were performed with prospective gating, unless heart rate was ≥70 beats/min, when retrospective gating was used. The aortic root and coronary arteries were assessed for artefact (significant artefact=1; artefact not limiting diagnosis=2; no artefact=3). Aortic scans were considered diagnostic if the score was >1; the coronaries, if all three epicardial arteries scored >1.ResultsThere was no significant difference in diagnostic image quality for either the aorta (artefact-free high-pitch: 31 (73%) scans vs standard-pitch: 40 (79%), p=0.340) or the coronary tree as a whole (10 (23%) vs 15 (29%), p=0.493). However, proximal coronary arteries were less well visualised using high-pitch acquisitions (16 (36%) vs 30 (59%), p=0.04). The median (IQR) radiation dose was significantly lower in the high-pitch cohort (dose-length product: 347 (318–476) vs 1227 (1150–1474) mGy cm, respectively, p<0.001), and the protocol required almost half the amount of contrast.ConclusionsThe high-pitch protocol significantly reduces radiation and contrast doses and is non-inferior to standard-pitch acquisitions for aortic assessment. For aortic root assessment, the high-pitch protocol is recommended. However, if coronary assessment is critical, this should be followed by a conventional standard-pitch, low-dose, prospectively gated CT-coronary angiogram if the high-pitch scan is non-diagnostic.

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“…However, respiratory motion artifacts often degrade the image quality of cardiothoracic CT in free-breathing children. The recently introduced high-pitch dual-source spiral CT imaging technique can provide excellent coronary artery image quality in adult patients ( 8 9 10 11 12 13 14 15 16 17 ) and substantially reduces respiratory motion artifacts in free-breathing patients ( 14 ). Two types of scan methods, non-ECG-synchronized and prospectively ECG-triggered methods, are available for high-pitch dual-source spiral CT imaging techniques ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Image Quality and Radiation Dose of High-Pitch Dual-Source Spiral Cardiothoracic Computed Tomography in Young Children with Congenital Heart Disease: Comparison of Non-Electrocardiography Synchronization and Prospective Electrocardiography Triggering

Goo

2018

Korean J Radiol

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ObjectiveTo compare image quality and radiation dose of high-pitch dual-source spiral cardiothoracic computed tomography (CT) between non-electrocardiography (ECG)-synchronized and prospectively ECG-triggered data acquisitions in young children with congenital heart disease.Materials and MethodsEighty-six children (≤ 3 years) with congenital heart disease who underwent high-pitch dual-source spiral cardiothoracic CT were included in this retrospective study. They were divided into two groups (n = 43 for each; group 1 with non-ECG-synchronization and group 2 with prospective ECG triggering). Patient-related parameters, radiation dose, and image quality were compared between the two groups.ResultsThere were no significant differences in patient-related parameters including age, cross-sectional area, body density, and water-equivalent area between the two groups (p > 0.05). Regarding radiation dose parameters, only volume CT dose index values were significantly different between group 1 (1.13 ± 0.09 mGy) and group 2 (1.07 ± 0.12 mGy, p < 0.02). Among image quality parameters, significantly higher image noise (3.8 ± 0.7 Hounsfield units [HU] vs. 3.3 ± 0.6 HU, p < 0.001), significantly lower signal-to-noise ratio (105.0 ± 28.9 vs. 134.1 ± 44.4, p = 0.001) and contrast-to-noise ratio (84.5 ± 27.2 vs. 110.1 ± 43.2, p = 0.002), and significantly less diaphragm motion artifacts (3.8 ± 0.5 vs. 3.7 ± 0.4, p < 0.04) were found in group 1 compared with group 2. Image quality grades of cardiac structures, coronary arteries, ascending aorta, pulmonary trunk, lung markings, and chest wall showed no significant difference between groups (p > 0.05).ConclusionIn high-pitch dual-source spiral pediatric cardiothoracic CT, additional ECG triggering does not substantially reduce motion artifacts in young children with congenital heart disease.

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Maximizing the clinical benefit of high-pitch, single-heartbeat CT coronary angiography in clinical practice

Cited by 8 publications

References 8 publications

Quality assurance in cardiovascular CT: a practical guide

Quality assurance in cardiovascular CT: a practical guide

High-pitch versus conventional cardiovascular CT in patients being assessed for transcatheter aortic valve implantation: a real-world appraisal

Image Quality and Radiation Dose of High-Pitch Dual-Source Spiral Cardiothoracic Computed Tomography in Young Children with Congenital Heart Disease: Comparison of Non-Electrocardiography Synchronization and Prospective Electrocardiography Triggering

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