Ultra-fast, low dose high-pitch (FLASH) versus prospectively-gated coronary computed tomography angiography: Comparison of image quality and patient radiation exposure

Smettei, Osama A.; Sayed, Sawsan; Habib, Abdullah M Al; Alharbi, Fahad J.; Abazid, Rami M.

doi:10.1016/j.jsha.2017.11.001

Cited by 18 publications

(13 citation statements)

References 23 publications

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“…This result was found to be consistent with previous studies (12,27,33). In order to use ash mode in dual-energy CT devices, patients' heart rates should be low (28,29). Therefore, in our study, it is expected that the heart rates of patients with CCTA-ash group are lower than the other groups.…”

Section: Discussionsupporting

confidence: 92%

Comparison of Radiation-Induced DNA Damage between Conventional and Computed Tomography Coronary Angiography

Gökalp

Ünlü

Yalçın

et al. 2021

Preprint

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Purpose: Conventional coronary angiography (CCA) and coronary computed tomography angiography (CCTA) are the most frequently used imaging modalities to diagnose coronary artery disease (CAD). The amount of radiation and genotoxic damages of these imaging methods showed variation with the improved technology. Thus we sought to compare the ionizing radiation doses and radiation-induced DNA damage in patients who were performed CCA and CCTA.Methods: 76 patients (39 in CCA group, 37 in CCTA group) were enrolled. Patients undergoing CCTA were grouped according to the use of flash technique (22 patients with CCTA-flash, 15 patients with CCTA-other). The effective radiation dose was recorded. Genotoxicity was compared with chromosome aberration test before and after imaging methods.Results: There was a significant difference between the groups in effective radiation doses given to patients. Radiation was lowest in the CCTA-flash group, followed by CCA, and non-flash CCTA group. There was no change in chromosome aberration rate after CCTA-flash group (p = 0.479). There was a significant increase in chromosome aberration rates after CCA and CCTA-other groups (CCA: p = 0.001; CCTA-other: p = 0.01). Conclusions: CTA which was taken with flash technique in dual-energy CT devices delivers lower dose radiation compared to other groups. Due to this significant difference, radiation-induced genetic damage was significantly less in patients with CCTA undergoing flash technique.

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Section: Discussionsupporting

confidence: 92%

Comparison of Radiation-Induced DNA Damage between Conventional and Computed Tomography Coronary Angiography

Gökalp

Ünlü

Yalçın

et al. 2021

Preprint

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“…Concerns on the robustness of HPSF imaging can be mitigated by our finding that the image quality of this approach is comparable to conventional scan regimes, in-line with results from other working groups that validated the image quality of high-pitch spiral scans [ 14 , 21 , 22 , 23 ]. Indeed, the diagnostic yield of CCTAs in the HPSF approach was comparable to a NHPSF approach, allowing 1399 of 1410 patients to benefit from a non-invasive, low-radiation coronary imaging with comparable negative predictive value to invasive coronary angiography [ 24 , 25 ].…”

Section: Discussionsupporting

confidence: 81%

Radiation Dose and Image Quality of a High-Pitch Prospective Spiral First Approach in Coronary Computed Tomography Angiography (CCTA)

Finck

Klambauer

Hendrich

et al. 2021

JCDD

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Objective: To investigate a high-pitch spiral first (HPSF) approach for coronary computed tomography angiography (CCTA) in an unselected patient cohort and compare diagnostic yield and radiation exposure to CCTAs acquired via conventional, non-high-pitch spiral first (NHPSF) scan regimes. Materials and Methods: All consecutive patients from 1/1/2015 to 31/12/2017 were included. Two investigation protocols (HPSF/NHPSF) were used with the aim to achieve diagnostic image quality of all coronary segments. Low-pitch secondary scans followed the initial examination if image quality was unsatisfactory. Dosage and image quality were compared between both regimes. Results: 1410 patients were subject to a HPSF and 236 patients to a NHPSF approach. While the HPSF approach led to a higher fraction of re-scans (35% vs. 11%, p < 0.001), the fraction of aggregate scans that remained non-diagnostic after considering the initial and secondary scan was comparably low for the HPSF and NHPSF approach (0.78 vs. 0%, p = 0.18). Aggregate radiation exposure in the HPSF protocol was significantly lower (1.12 mSv (IQR: 0.73, 2.10) vs. 3.96 mSv (IQR: 2.23, 8.33) p < 0.001). Conclusions: In spite of a higher number of re-scans, a HPSF approach leads to a reduction in overall radiation exposure with diagnostic yields similar to a NHPSF approach.

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“…Source-based DECT approaches that involved dual-source CT that typically uses the traditional helical retrospective scan protocols at a higher radiation dose (42). Lower effective radiation dose can be obtained via prospectively ECG-triggered highpitch spiral modes combined with lower polychromatic tube energies but in the conventional mode with no dual energy information available (43,44). DECT investigations for coronary imaging using this mode of scanning are, therefore, currently lacking.…”

Section: Discussionmentioning

confidence: 99%

The optimal monoenergetic spectral image level of coronary computed tomography (CT) angiography on a dual-layer spectral detector CT with half-dose contrast media

Huang¹,

Gao²,

Ma³

et al. 2020

Quant Imaging Med Surg

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Background: To investigate the optimal monoenergetic level of spectral reconstructions in coronary computed tomography angiography (coronary CTA) on a dual-layer spectral detector computed tomography (SDCT) with half-dose contrast media.Methods: Two hundred patients with suspected coronary artery disease (CAD) were enrolled in this prospective coronary CTA study and randomly divided into a routine-dose contrast media group and a half-dose contrast media group (each n=100). Coronary CTA was performed using SDCT with prospective electrocardiogram (ECG)-gated mode. A tube voltage of 120 kVp was used, along with an automated tube current modulation. A dose of iodixanol 270 mgI/mL of 0.8 and 0.4 mL/kg was administered to the routine and half-dose groups, respectively. For the routine-dose group, 120 kVp polychromatic images with a model-based iterative reconstruction (IMR) (Group A) were reconstructed. For the half-dose group, three monoenergetic levels of images were reconstructed (Group B, 45 keV; Group C, 50 keV; and Group D, 55 keV).Objective indicators [mean CT values; noise; signal-to-noise ratio (SNR); and contrast-to-noise ratio (CNR)] and subjective indicators (contrast, sharpness, subjective noise, and acceptability) in each group were compared.Results: There were no significant differences in demographics or radiation dose (1.83±0.51 vs. 1.80± 0.53 mSv, P=0.78) between the routine-and half-dose groups. The average iodine loads were 15.33±2.26 and 7.48±1.14 g, respectively. Mean CT values, SNR, CNR, and subjective contrast in Group C were higher than those in Group A (P<0.05), and there were no significant differences in other indicators between Group C and Group A (P>0.05). The objective and subjective noise in Group B were worse than those in Group A (P<0.05). The contrast, sharpness, and acceptability of Group D were all worse than those of Group A (P<0.05).Conclusions: Compared to routine polychromatic images, 50 keV monoenergetic images can provide equivalent or improved coronary image quality in coronary CTA performed on SDCT with half the amount of contrast media.

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Ultra-fast, low dose high-pitch (FLASH) versus prospectively-gated coronary computed tomography angiography: Comparison of image quality and patient radiation exposure

Abstract: The use of 256-slice CCTA performed with the FLASH protocol has a better objective and subjective image quality as well as lower radiation exposure when compared with the use of prospective electrocardiography gating.

Cited by 18 publications

References 23 publications

Comparison of Radiation-Induced DNA Damage between Conventional and Computed Tomography Coronary Angiography

Comparison of Radiation-Induced DNA Damage between Conventional and Computed Tomography Coronary Angiography

Radiation Dose and Image Quality of a High-Pitch Prospective Spiral First Approach in Coronary Computed Tomography Angiography (CCTA)

The optimal monoenergetic spectral image level of coronary computed tomography (CT) angiography on a dual-layer spectral detector CT with half-dose contrast media

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