PGT coronary CT angiography offers improved image quality and substantially reduced effective radiation dose compared with traditional RGH coronary CT angiography.

Coronary artery imaging with x-ray computed tomography (CT) is one of the most recent advancements in CT clinical applications. Although existing "state-of-the-art" clinical protocols today utilize helical data acquisition, it suffers from the lack of ability to handle irregular heart rate and relatively high x-ray dose to patients. In this paper, we propose a step-and-shoot data acquisition protocol that significantly overcomes these shortcomings. The key to the proposed protocol is the large volume coverage (40 mm) enabled by the cone beam CT scanner, which allows the coverage of the entire heart in 3 to 4 steps. In addition, we propose a gated complementary reconstruction algorithm that overcomes the longitudinal truncation problem resulting from the cone beam geometry. Computer simulations, phantom experiments, and clinical studies were conducted to validate our approach.

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We present the results of dose and image quality performance evaluation of a novel, prospective ECG-gated Coronary CT Angiography acquisition mode (SnapShot Pulse, LightSpeed VCT-XT scanner, GE Healthcare, Waukesha, WI), and compare it to conventional retrospective ECG gated helical acquisition in clinical and phantom studies. Image quality phantoms were used to measure noise, slice sensitivity profile, in-plane resolution, low contrast detectability and dose, using the two acquisition modes. Clinical image quality and diagnostic confidence were evaluated in a study of 31 patients scanned with the two acquisition modes. Radiation dose reduction in clinical practice was evaluated by tracking 120 consecutive patients scanned with the prospectively gated scan mode. In the phantom measurements, the prospectively gated mode resulted in equivalent or better image quality measures at dose reductions of up to 89% compared to non-ECG modulated conventional helical scans. In the clinical study, image quality was rated excellent by expert radiologist reviewing the cases, with pathology being identical using the two acquisition modes. The average dose to patients in the clinical practice study was 5.6 mSv, representing 50% reduction compared to a similar patient population scanned with the conventional helical mode.

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