Achieving Very-Low-Dose Radiation Exposure in Cardiac Computed Tomography, Single-Photon Emission Computed Tomography, and Positron Emission Tomography

Dey, Damini; Slomka, Piotr J.; Berman, Daniel S.

doi:10.1161/circimaging.113.000897

Cited by 14 publications

(5 citation statements)

References 77 publications

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“…Finally, there is a current trend towards lower activities and patient-specific dose protocols. 31 , 32 Lowering the activity can easily be achieved by enlarging the scan time, as both are interchangeable within a certain range. In this study, we showed that a scan time up to 8 minutes does not introduce significant motion.…”

Section: Discussionmentioning

confidence: 99%

Value of automatic patient motion detection and correction in myocardial perfusion imaging using a CZT-based SPECT camera

Dijk

Dalen

Mouden

et al. 2018

Journal of Nuclear Cardiology

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BackgroundCorrection of motion has become feasible on cadmium-zinc-telluride (CZT)-based SPECT cameras during myocardial perfusion imaging (MPI). Our aim was to quantify the motion and to determine the value of automatic correction using commercially available software.Methods and ResultsWe retrospectively included 83 consecutive patients who underwent stress-rest MPI CZT-SPECT and invasive fractional flow reserve (FFR) measurement. Eight-minute stress acquisitions were reformatted into 1.0- and 20-second bins to detect respiratory motion (RM) and patient motion (PM), respectively. RM and PM were quantified and scans were automatically corrected. Total perfusion deficit (TPD) and SPECT interpretation—normal, equivocal, or abnormal—were compared between the noncorrected and corrected scans. Scans with a changed SPECT interpretation were compared with FFR, the reference standard. Average RM was 2.5 ± 0.4 mm and maximal PM was 4.5 ± 1.3 mm. RM correction influenced the diagnostic outcomes in two patients based on TPD changes ≥7% and in nine patients based on changed visual interpretation. In only four of these patients, the changed SPECT interpretation corresponded with FFR measurements. Correction for PM did not influence the diagnostic outcomes.ConclusionRespiratory motion and patient motion were small. Motion correction did not appear to improve the diagnostic outcome and, hence, the added value seems limited in MPI using CZT-based SPECT cameras.Electronic supplementary materialThe online version of this article (doi:10.1007/s12350-016-0571-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Value of automatic patient motion detection and correction in myocardial perfusion imaging using a CZT-based SPECT camera

Dijk

Dalen

Mouden

et al. 2018

Journal of Nuclear Cardiology

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“…Positron emission tomography (PET) stress testing, which was not used in PROMISE, may provide lower dose examinations, with expert PET sites reporting low radiation doses on the order of 3 mSv for 82 Rb, 13 N-ammonia, and 15 O-water based protocols. 40 Stress perfusion cardiovascular magnetic resonance (CMR) was not performed in PROMISE, but could have provided an alternative with no radiation dose. 41 …”

Section: Discussionmentioning

confidence: 99%

Safety of coronary CT angiography and functional testing for stable chest pain in the PROMISE trial: A randomized comparison of test complications, incidental findings, and radiation dose

Douglas

Udelson

et al. 2017

Journal of Cardiovascular Computed Tomography

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Coronary CT angiography (CTA) and functional testing strategies for stable chest pain yield similar outcomes; one aspect that may guide test choice is safety. We compared test safety (test complications, incidental findings, and effective radiation dose) between CTA and functional testing as-tested in PROMISE (PROspective Multicenter Imaging Study for Evaluation of Chest Pain). In the subgroup whose physicians intended nuclear stress over other functional tests if randomized to the functional arm, we compared radiation dose of CTA versus nuclear stress and identified characteristics associated with dose. Of 9,470 patients, there were no major and <1% minor complications (CTA: 0.8% [37/4,633] vs. functional: 0.6% [27/4,837]). CTA identified more incidental findings (11.6% [539/4,633] vs. 0.7% [34/4,837], p<0.001), most commonly pulmonary nodules (9.4%, 437/4,633). CTA had similar 90-day cumulative radiation dose to overall functional testing. However, in the subgroup whose physicians intended nuclear stress (CTA 3,147; nuclear 3,203), CTA had lower median index test (8.8 vs. 12.6 mSv, p<0.001) and 90-day cumulative (11.6 vs. 13.1 mSv, p <0.001) dose, independent of patient characteristics. The lowest nuclear stress doses employed 1-day Tc-99m protocols (12.2 mSv). The lowest CTA doses were at sites performing ≥500 CTAs/year (6.9 mSv) and with advanced (latest available) CT scanners (5.5 mSv). In conclusion, complications were negligibly rare for both CTA and functional testing. CTA detects more incidental findings. Compared to nuclear stress testing, CTA’s lower radiation dose, independent of patient characteristics, makes it an attractive test choice. Radiation dose varies with imaging protocol, indicating opportunities to further reduce dose. (ClinicalTrials.gov number, NCT01174550)

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“…However, high tube currents and low pitch factor both result in high radiation exposure to the patients. To reduce radiation dose from coronary CTA, the prospectively gated transverse acquisition should be considered for patients with stable and low heart rates [ 32 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Impact of Factors Affecting CT Radiation Dose for Optimizing Patient Dose Levels

Yang

2020

Diagnostics

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The dose metrics and factors influencing radiation exposure for patients undergoing head, chest, and abdominal computed tomography (CT) scans were investigated for optimization of patient dose levels. The local diagnostic reference levels (DRLs) of adult CT scans performed in our hospital were established based on 28,147 consecutive examinations, including 5510 head scans, 9091 chest scans, and 13,526 abdominal scans. Among the six CT scanners used in our hospital, four of them are 64-slice multi-detector CT units (MDCT64), and the other two have detector slices higher than 64 (MDCTH). Multivariate analysis was conducted to evaluate the effects of body size, kVp, mAs, and pitch on volume CT dose index (CTDIvol). The local DRLs expressed in terms of the 75th percentile of CTDIvol for the head, chest, and abdominal scans performed on MDCT64 were 59.32, 9.24, and 10.64 mGy, respectively. The corresponding results for MDCTH were 57.90, 7.67, and 9.86 mGy. In regard to multivariate analysis, CTDIvol showed various dependence on the predictors investigated in this study. All regression relationships have coefficient of determination (R2) larger than 0.75, indicating a good fit to the data. Overall, the research results obtained through our workflow could facilitate the modification of CT imaging procedures once the local DRLs are unusually high compared to the national DRLs.

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Achieving Very-Low-Dose Radiation Exposure in Cardiac Computed Tomography, Single-Photon Emission Computed Tomography, and Positron Emission Tomography

Abstract: The x-ray tube current, expressed in units of milliamperes (mA), is the number of electrons accelerated across an x-ray (Circ Cardiovasc Imaging. 2014;7:723-734.)

Cited by 14 publications

References 77 publications

Value of automatic patient motion detection and correction in myocardial perfusion imaging using a CZT-based SPECT camera

Value of automatic patient motion detection and correction in myocardial perfusion imaging using a CZT-based SPECT camera

Safety of coronary CT angiography and functional testing for stable chest pain in the PROMISE trial: A randomized comparison of test complications, incidental findings, and radiation dose

Evaluation of Impact of Factors Affecting CT Radiation Dose for Optimizing Patient Dose Levels

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