Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose–Reduction Techniques

Abstract

ORONARY ARTERY DISEASE REmains the most frequent cause of death and disability in the developed world and rates are increasing among developing nations. 1 As the population at risk has increased, national health care systems are under financial pressure to deliver cost-effective diagnosis and risk stratification of symptomatic patients suspected of having coronary ischemia. Noninvasive multislice cardiac computed tomography angiography (CCTA) has emerged since 2000 as a new diagnostic test with the potential to efficiently address this challenge. 2,3 Multiple studies of the accuracy of CCTA compared with invasive coronary angiography in thousands of patients have documented sensitivities and negative predictive values in the range of 90%. 4-6 This suggests that CCTA may definitively exclude the diagnosis of coronary artery disease in a substantial proportion of appropriately selected patients, allowing scarce

An education and training programme for radiological institutes: impact on the reduction of the CT radiation dose

“…Two recent investigations have confirmed our findings that educational initiatives can successfully reduce the CT radiation dose [27,28]. Raff and coworkers reported an average reduction of 53% in the radiation dose for cardiac CT in 15 radiological institutes by adopting a best-practice CT model [27]. This best-practice CT model included a minimised imaging range, a heart rate reduction, electrocardiographic-gated tube current modulation, and reduced tube voltage in patients, where applicable.…”

“…Recently, awareness campaigns for paediatric and adult CT imaging have been launched in the United States [25,26]. Two recent investigations have confirmed our findings that educational initiatives can successfully reduce the CT radiation dose [27,28]. Raff and coworkers reported an average reduction of 53% in the radiation dose for cardiac CT in 15 radiological institutes by adopting a best-practice CT model [27].…”

Decision Analytic Model for Evaluation of Suspected Coronary Disease with Stress Testing and Coronary CT Angiography

“…17,18 For the purpose of sensitivity analysis, since many centers have not yet adopted prospectively gated cCTA, the effective dose of cCTA was also varied up to 10mSv as demonstrated in a recent multicenter trial using the more conventional helical CTA with tube current modulation. 19 The effective dose for diagnostic cardiac catheterization was set at 7mSv for the base analysis, but was varied down to 5mSv for the sensitivity analysis. 20,21 Imaging/testing costs were computed as a combination of professional and technical fees as reported in table 3.…”

Prospective helical acquisition for coronary CT angiography

“…However, the reported effective doses of coronary CT angiography using retrospective ECG gating are rather high, ranging from about 15 to 20 mSv [4,5]. Prospective ECG gating with acquisition of axial datasets (also called ''step-and-shoot'') is an established CT scanning technique that has been used for a long time for coronary artery calcium scoring and has recently also been employed as a very promising concept to reduce the effective dose of coronary CT angiography [6][7][8].…”