Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 (PROTECTION VI)

Stocker, Thomas J.; Deseive, Simon; Heckner, Mathias; Pontone, Gianluca; Marques, Hugo; Chow, Benjamin J.W.; Tabbalat, Ramzi; Schmermund, Axel; Kang, Joon‐Won; Naoum, Christopher; Martuscelli, Eugenio; Maßberg, Steffen; Hausleiter, Jörg; Carrascosa, Patrícia; Deviggiano, Alejandro; Magnussen, John; Otton, James; Kaplan, Anthony; Feuchtner, Gudrun; Plank, Fabian; Smet, Kristof De; Buls, Nico; Cury, Roberto Caldeira; Bittencourt, Márcio Sommer; Nomura, César Higa; Dantas, Roberto Nery; Leipsic, Jonathon; Blanke, Philipp; Chartrand-Lefèbvre, Carl; Chin, Anne S.; Small, Gary; Z, Marcelo Godoy; F, Claudio Silva; Fang, Xiangming; Wang, Jie; Cadena, Alberto; Adla, Theodor; Suchánek, Vojtěch; Grove, Erik Lerkevang; Pedersen, Kamilla; Lambrechtsen, Jess; Husic, Mirza; Knuuti, Juhani; Maaniitty, Teemu; Bischoff, Bernhard; Arnoldi, Elisabeth; Eckert, J.; Hadamitzky, Martin; Finck, Tom; Hell, Michaela M.; Marwan, Mohamed; Bamberg, Fabian; Mangold, Stefanie; Schlosser, Thomas; Ludwig, Johannes; Mylona, Maria; Skiadopoulos, Spyros; Maurovich-Horvat, Pál; Szilveszter, Bálint; Jadav, Uday; Pinto, Brian V; Rubinshtein, Ronen; Hussein, Essam; Andreini, Daniele; Sperandio, Massimiliano; Kitagawa, Kakuya; Nagasawa, Naoki; Farhan, Rami A; Delgado, Leovigildo A; Galán, Lilia M Sierra; Orozco, Marco A Reza; Castellón, Francisco C; Zamudio, Mariana Diaz; Preciado-Anaya, Andrés; Gómez, Rafael P; Forsdahl, Signe Helene; Hansen, Grete Anita; Günther, Anne; Kristiansen, Joanna; Huapalla, Edith Chavez; Chavez, Percy Teran; Gonçalves, Pedro de Araújo; Ramanathan, Subramaniyan; Синицын, В. Е.; Glazkova, Maria; Abazid, Rami M.; Smettei, Osama A.; Dawood, Ahmed; Omar, Salama Hussain; Yang, Dong Hyun; Kim, Tae Hoon; Park, Chul Hwan; Shin, Sanghoon; Ryu, Seok Jong; Palomares, Jose R; Cuéllar, Hug; Bax, Jeroen J.; Rosendael, Alexander van; Williams, Michelle; Newby, David E.; Beek, Edwin Jacques Rudolph van; Bull, Russell; Jayawardhana, Kavin; Dickson, Patricia I.; Espey, Jennifer; Lesser, John R.; Han, Bo; Bullock-Palmer, Renée P.; Rabbat, Mark; Schoenecker, Nancy; Thomas, Dustin; Gore, Rosco; Atkins, Melany; Chen, Marcus Y; Shanbhag, Sujata M.; Mahmarian, John J.; Yu, Jeannie; Villines, Todd C.; Nguyen, Binh

doi:10.1093/eurheartj/ehy546

Cited by 172 publications

(114 citation statements)

References 28 publications

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“…However, lower kV acquisitions are becoming increasingly popular in order to reduce radiation and contrast medium volume. Recent results from the PROTECTION VI Study showed that low kV settings for cCTA (< 100 kV) are already applied in 14% of patients and this is only expected to increase [27,28]. Our results showed significant differences between all kV levels except between 80 and 90 kV, and between 100 and 120 kV.…”

Section: Discussionmentioning

confidence: 49%

Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Ties

Assen

et al. 2020

Eur Radiol

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Objectives To determine normal pericoronary adipose tissue mean attenuation (PCATMA) values for left the anterior descending (LAD), left circumflex (LCX), and right coronary artery (RCA) in patients without plaques on coronary CT angiography (cCTA), taking into account tube voltage influence. Methods This retrospective study included 192 patients (76 (39.6%) men; median age 49 years (range, 19–79)) who underwent cCTA with third-generation dual-source CT for the suspicion of CAD between 2015 and 2017. We selected patients without plaque on cCTA. PCATMA was measured semi-automatically on cCTA images in the proximal segment of the three main coronary arteries with 10 mm length. Paired t-testing was used to compare PCATMA between combinations of two coronary arteries within each patient, and one-way ANOVA testing was used to compare PCATMA in different kV groups. Results The overall mean ± standard deviation (SD) PCATMA was − 90.3 ± 11.1 HU. PCATMA in men was higher than that in women: − 88.5 ± 10.5 HU versus − 91.5 ± 11.3 HU (p = 0.001). PCATMA of LAD, LCX, and RCA was − 92.4 ± 11.6 HU, − 88.4 ± 9.9 HU, and − 90.2 ± 11.4 HU, respectively. Pairwise comparison of the arteries showed significant difference in PCATMA: LAD and LCX (p < 0.001), LAD and RCA (p = 0.009), LCX and RCA (p = 0.033). PCATMA of the 70 kV, 80 kV, 90 kV, 100 kV, and 120 kV groups was − 95.6 ± 9.6 HU, − 90.2 ± 11.5 HU, − 87.3 ± 9.9 HU, − 82.7 ± 6.2 HU, and − 79.3 ± 6.8 HU, respectively (p < 0.001). Conclusions In patients without plaque on cCTA, PCATMA varied by tube voltage, with minor differences in PCATMA between coronary arteries (LAD, LCX, RCA). PCATMA values need to be interpreted taking into account tube voltage setting. Key Points • In patients without plaque on cCTA, PCATMAdiffers slightly by coronary artery (LAD, LCX, RCA). • Tube voltage of cCTA affects PCATMAmeasurement, with mean PCATMAincreasing linearly with increasing kV. • For longitudinal cCTA analysis of PCATMA, the use of equal kV setting is strongly recommended.

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Section: Discussionmentioning

confidence: 49%

Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Ties

Assen

et al. 2020

Eur Radiol

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“…37 Modern CTCA is an excellent test to non-invasively identify the presence of atherosclerosis in the coronary arteries at a low radiation dose. 38 The presence of CAD on CTCA has been linked to cardiac events in persons with diabetes, and conversely the absence of CAD on CTCA with a low event rate. 24,25,39,40 The FACTOR 64 RCT, which was underpowered due to fewer events than anticipated, did not find a benefit of using CTCA to screen participants with a mean diabetes duration of 12 years for CAD.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study

Holte

Svanteson

Hanssen

et al. 2019

Journal of Diabetes and its Complications

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Aims: We studied the total prevalence of obstructive coronary artery disease (CAD), undiagnosed CAD and absent CAD in persons with ≥45-year duration of type 1 diabetes (T1D) versus controls, and associations with mean HbA 1c , LDL-cholesterol and blood pressure over 2-3 decades. Methods: We included 76% (n=103) of all persons with T1D diagnosed ≤1970 attending a diabetes center and 63 controls without diabetes. We collected 20-30 years of HbA 1c , LDLcholesterol and blood pressure measurements. Participants without previously diagnosed coronary heart disease (CHD) underwent Computed Tomography Coronary Angiography (CTCA). Undiagnosed obstructive CAD was defined as any coronary stenosis >50% on CTCA, absent CAD as no detected plaque, and total obstructive CAD as either obstructive CAD on CTCA or previous CHD diagnosis. Results: The prevalence of undiagnosed, absent and obstructive CAD was 24% (21/88), 16% (14/88) and 35% (36/103) in T1D versus 10% (6/60), 50% (30/60) and 14% (9/63) in controls (all p<0.05). Mean HbA 1c was associated with undiagnosed obstructive CAD (OR 2.30 95% C.I. 1.13-4.69), while mean LDL-cholesterol was inversely associated with absent CAD (0.12, 0.04-0.43). Conclusions: The prevalence of undiagnosed obstructive CAD was high (24%) in this cohort of long-term survivors with T1D. Mean LDL-cholesterol and HbA 1c were associated with CAD.

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“…For coronary CT angiography, the UK has the lowest international diagnostic reference levels set by Ionising Radiation (Medical Exposure) Regulations at 380 mGy.cm for retrospective acquisitions with ECG gating and 170 mGy.cm for prospective acquisitions with no padding 12. Focusing attention on the optimal scan acquisition in the field of coronary CT angiography has resulted in many centres switching from retrospective to prospective acquisitions and reducing tube current potential, thereby reducing the median radiation exposure by 78% 13 14. In this study, the wide variation in scanning techniques for acquiring CT-TAVI data sets would suggest that there is scope to lower radiation dose exposure through improved standardisation of practice across UK cardiac CT centres.…”

Section: Discussionmentioning

confidence: 99%

CT imaging prior to transcatheter aortic valve implantation in the UK

et al. 2020

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ObjectiveThis cross-sectional observational study sought to describe variations in CT in the context of transcatheter aortic valve implantation (CT-TAVI) as currently performed in the UK.Methods408 members of the British Society of Cardiovascular Imaging were invited to complete a 27-item online CT-TAVI survey.Results47 responses (12% response rate) were received from 40 cardiac centres, 23 (58%) of which performed TAVI on-site (TAVI centres). Only six respondents (13%) performed high-volume activity (>200 scans per year) compared with 13 (28%) performing moderate (100–200 scans per year) and 27 (59%) performing low (0–99 scans per year) volume activity. Acquisition protocols varied (41% retrospective, 12% prospective with wide padding, 47% prospective with narrow padding), as did the phase of reporting (45% systolic, 37% diastolic, 11% both, 6% unreported). Median dose length product was 675 mGy.cm (IQR 477–954 mGy.cm). Compared with non-TAVI centres, TAVI centres were more likely to report minimum iliofemoral luminal diameter (n=25, 96% vs n=7, 58%, p=0.003) and optimal tube angulation for intervention (n=12, 46% vs n=1, 8%, p=0.02).ConclusionsThis national survey formally describes current CT-TAVI practice in the UK. High-volume activity was only present at one in seven cardiac CT centres. There is wide variation in scan acquisition, scan reporting and radiation dose exposure in cardiac CT centres.

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Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 (PROTECTION VI)

Cited by 172 publications

References 28 publications

Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Towards reference values of pericoronary adipose tissue attenuation: impact of coronary artery and tube voltage in coronary computed tomography angiography

Undiagnosed coronary artery disease in long-term type 1 diabetes. The Dialong study

CT imaging prior to transcatheter aortic valve implantation in the UK

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