Radiation Dose Reduction and Coronary Assessability of Prospective Electrocardiogram-Gated Computed Tomography Coronary Angiography

Maruyama, Takao; Takada, Masanori; Hasuike, T; Yoshikawa, Akiko; Namimatsu, Eiji; Yoshizumi, Tohru

doi:10.1016/j.jacc.2008.07.048

Cited by 160 publications

(95 citation statements)

References 19 publications

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“…Our study adds to the previous knowledge [1][2][3][4][5][6][7][8] on CTCA with prospective ECG triggering with the following results: (1) the heart rate can be reduced by about 5 bpm by choosing the adequate level of breath-hold for CTCA in each patient individually; (2) the maximum heart rate reduction during breath-hold can be obtained at normal inspiration levels in 9% of patients, at intermediate inspiration levels in 39% of patients and at deep inspiration in 52% of patients; (3) coronary vessel attenuation is not influenced by the level of breath-hold; and (4) in 10% of patients backflow of contrast material into the inferior vena cava (as an indicator of increased intrathoracic pressure) can be observed, and, if backflow occurs, coronary vessel attenuation is reduced and correlated with the level of breath-hold.…”

Section: Discussionsupporting

confidence: 70%

“…Low-dose CT coronary angiography (CTCA) with prospective electrocardiogram (ECG) triggering has recently been introduced [1] and shown to offer a tremendous reduction in radiation dose [2][3][4][5][6][7][8], which makes its widespread clinical use feasible. Scanning in CTCA with prospective ECG triggering is exclusively performed during a short phase in diastole, called \diastasis".…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, an aggressive reduction in heart rate with bblockers is required for low-dose CTCA with prospective ECG triggering. Different groups have concordantly reported the administration of high doses of b-blockers [2][3][4][5][6][7], but nonetheless a certain percentage of patients could not be scanned, as heart rate reduction with bblockers was not sufficient [2][3][4][5][6][7][8].…”

Section: Discussionmentioning

confidence: 99%

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Lowering heart rate with an optimised breathing protocol for prospectively ECG-triggered CT coronary angiography

Husmann

Herzog²,

Pazhenkottil³

et al. 2011

BJR

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Objectives: The aim was to prospectively characterise the effect of the level of breathhold on heart rate in CT coronary angiography (CTCA) with prospective electrocardiogram (ECG) triggering and its impact on coronary artery attenuation. Methods: 260 patients (86 women; mean age 59 ¡ 11 years) underwent 64-slice CTCA using prospective ECG triggering. Prior to CTCA, heart rates were recorded during 15 s of breath-hold at three different levels of inspiration (normal, intermediate and deep). The inspiration level with the lowest heart rate was chosen for actual CTCA scanning. Coronary artery attenuation was measured, and the presence of backflow of contrast material into the inferior vena cava (as an indicator of increased intrathoracic pressure) was recorded. Results: The mean heart rate at breath-hold was significantly different for the three inspiration levels (normal, 60 ¡ 8 bpm; intermediate, 59 ¡ 8 bpm; deep, 57 ¡ 7 bpm; p,0.001). The maximum heart rate reduction in each patient at breath-hold averaged 5.3 ¡ 5.1 bpm, and was observed at a normal inspiration depth in 23 (9%) patients, at an intermediate inspiration depth in 102 (39%) patients and at deep inspiration in 135 (52%) patients. Overall, there was no association between the level of breath-hold and coronary vessel attenuation (p-value was not significant). However, the backflow of contrast material into the inferior vena cava (n526) was found predominantly at deep inspiration levels (p,0.001), and, when it occurred, it was associated with reduced coronary attenuation compared with patients with no backflow (p,0.05). Conclusion: The breath-hold level to best reduce heart rate for CTCA should be individually assessed prior to scanning because a mean heart rate reduction of 5 bpm can be achieved. Low-dose CT coronary angiography (CTCA) with prospective electrocardiogram (ECG) triggering has recently been introduced [1] and shown to offer a tremendous reduction in radiation dose [2-8], which makes its widespread clinical use feasible. Scanning in CTCA with prospective ECG triggering is exclusively performed during a short phase in diastole, called \diastasis". The new technique appears to be more prone to artefacts caused by coronary motion. This is especially true in higher heart rates because diastasis disproportionally shortens with increasing heart rates [9] and the length of diastasis becomes shorter than the time required for image acquisition when the heart rate exceeds a certain threshold. Furthermore, when low-dose CTCA with prospective ECG triggering is performed with the smallest possible acquisition window to achieve the lowest possible radiation dose, it does not permit image reconstruction in other phases of the cardiac cycle to compensate for a possible reduction in image quality. An aggressive reduction in heart rate with b-blockers below a target heart rate of 63 bpm appears to be a prerequisite for lowdose CTCA [2,10].CTCA is generally performed during the patient's breath-hold to avoid motion artefacts caused by movement of the thora...

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Lowering heart rate with an optimised breathing protocol for prospectively ECG-triggered CT coronary angiography

Husmann

Herzog²,

Pazhenkottil³

et al. 2011

BJR

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“…Este estudio se realizó con una adquisición prospectiva la cual como se demuestra en el estudio de Maruyama [10] donde se obtuvo disminuciones sustanciales de la dosis de radiación efectiva de 21 ± 6.7 mSv al 4.3 ±1.3 mSv sin perjuicio en la calidad del estudio con porcentajes de segmentos evaluables del 96.6 %. [11].…”

Section: Discussionunclassified

Estudio Descriptivo: Dosis Efectiva de Radiación en Angiotomografías Coronarias Multidetector de Enero del 2013 a Diciembre del 2015 en el Hospital de Especialidades José Carrasco Arteaga

et al. 2017

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134 RESUMEN INTRODUCCIÓN:La coronariografia convencional sigue siendo el patrón de referencia para cuantificar y guiar el tratamiento en la enfermedad coronaria sin embargo con la introducción de la angiotomografía coronaria multidetector en la valoración de placas ateromatosas coronarias y con esto la exposición a la radiación ha permanecido como área de constante preocupación. En la práctica diaria se recomienda basarse en lo que se conoce como As Low As Reasonably Achievable que significa optimizar la radiación sin perjuicio de la calidad del estudio. MÉTODOS:Se trata de un estudio descriptivo retrospectivo en el Hospital de Especialidades José Carrasco Arteaga de Cuenca -Ecuador, durante el periodo de tiempo comprendido entre el 01 enero del 2013 y 31 diciembre del 2015. Para este estudio se incluyeron todos los pacientes a quienes se les realizó angiotomografía coronaria multidetector, se recolectaron los datos clínicos y la dosis efectiva de radiación de cada paciente. RESULTADOS:La edad promedio fue de 63.2 años. Con una probabilidad pre-test intermedia-baja para enfermedad coronaria en más del 94 % de los pacientes, de los cuales el promedio de dosis de radiación efectiva en angiotomografía coronaria multidetector es de 13.0276 mSv (0.9002 -20.657). CONCLUSION:Se trata del primer estudio en el medio donde investiga la dosis de radiación utilizada en angiotomografía coronaria multidetector permitiendo conocer la media de dosis efectiva y así optimizar la misma mediante técnicas de reducción. . DESCRIPTORES CONCLUSIONS:This is the first study in our area where the dose of radiation used in multidetector coronary angiothomography has been investigated, making it possible to identify the effective half dose, in this way optimizing the same through the use of reduction techniques.

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“…The use of 100 kVp scan protocols (as opposed to the ''traditional'' 120 kVp) reduces radiation dose by as much as 40% without influencing image quality, at least in individuals with a low body weight [1,5]. Finally, prospectively triggered data acquisition leads to substantial reduction of radiation dose, with doses reported between 1.2 and 4.3 mSv [6][7][8][9][10][11].…”

mentioning

confidence: 99%

Limiting radiation exposure in coronary CT angiography: much can be achieved with little extra effort

Achenbach

2009

Int J Cardiovasc Imaging

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Radiation Dose Reduction and Coronary Assessability of Prospective Electrocardiogram-Gated Computed Tomography Coronary Angiography

Abstract: MDCT-CA by prospective gating showed equivalent coronary assessability and diagnostic accuracy with decreased radiation dose in comparison with a retrospective ECG-gated helical scan with tube current modulation.

Cited by 160 publications

References 19 publications

Lowering heart rate with an optimised breathing protocol for prospectively ECG-triggered CT coronary angiography

Lowering heart rate with an optimised breathing protocol for prospectively ECG-triggered CT coronary angiography

Estudio Descriptivo: Dosis Efectiva de Radiación en Angiotomografías Coronarias Multidetector de Enero del 2013 a Diciembre del 2015 en el Hospital de Especialidades José Carrasco Arteaga

Limiting radiation exposure in coronary CT angiography: much can be achieved with little extra effort

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