Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques

Arnoldi, Elisabeth; Johnson, Thorsten R. C.; Rist, Carsten; Wintersperger, Bernd J.; Sommer, Wieland H.; Becker, Alexander; Becker, Christoph; Reiser, Maximilian; Nikolaou, Konstantin

doi:10.1007/s00330-009-1411-9

Cited by 62 publications

(42 citation statements)

References 35 publications

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“…(2,(5)(6)(7)(8)(9)14,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) The attrition diagram for our study depicting the search process is shown in Fig. 2 Table III.…”

Section: Resultsmentioning

confidence: 99%

Coronary computed tomography angiography with prospective electrocardiography triggering: a systematic review of image quality and radiation dose

Sabarudin

Sun

2013

SMedJ

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Singapore Med J 2013; 54(1) : 15 R ev iew A r tic le INTRODUCTIONCoronary computed tomography angiography (CCTA) has been widely used as a valuable diagnostic imaging modality for the noninvasive assessment of coronary artery disease (CAD). It has become a reliable and accurate modality to assess the coronary arteries of patients with suspected CAD.(1) Previous studies have found that retrospective electrocardiography (ECG)-gated CCTA provides high sensitivity (range 86%-99%) and specificity (range 89%-100%) for coronary artery stenosis, and also results in high negative predictive values (NPVs; range 96%-99%).(2,3)Prospective ECG-gated CCTA also promises high sensitivity (range 93.7%-100.0%), specificity (range 82.7%-97.0%) and NPV (range 95%-98%) in the assessment of CAD. (2,3) Although high diagnostic accuracy is achieved with both retrospective and prospective ECG-gated CCTA for detecting CAD (Fig. 1), the radiation doses associated with these two cardiac examinations are significantly different due to the different approaches used for coronary artery scanning.It is well known that CCTA with retrospective ECG gating leads to high radiation doses of up to 31.4 mSv since volumetric data of the heart is acquired during continuous scans in this modality, although only a portion of the data is used for reconstruction. (4,5) In contrast, with exposure taking place at selective phases of the cardiac cycle in patients with low and regular heart rate, prospective ECG triggering is associated with very low radiation doses, which indicates a significant reduction in effective doses of up to 87%. (6) Several studies that used prospective ECG-gated CCTA have reported significantly reduced radiation doses. (7)(8)(9)(10)(11)(12) However, the diagnostic image quality of prospective triggering in the assessment of coronary arteries or CAD has not been systematically studied. Therefore, the purpose of this study was to investigate previous studies that assessed the coronary artery using prospective ECG-triggered CCTA for the detection of CAD, in terms of image quality and radiation dose via a systematic review of the current literature. METHODS Literature searchA ABSTRACT The purpose of this study was to perform a systematic review of the diagnostic accuracy, image quality and radiation dose of prospective electrocardiography (ECG)-triggered coronary computed tomography angiography (CCTA). We searched databases containing studies of CCTA that used prospective ECG-triggering between 2008 and 2011. The effective dose and image quality reported in each study were analysed and compared between the types of multislice CT scanners. We identified 23 studies through this search, with mean assessable coronary segments and effective dose at 96.8% (95% confidence level [CI] 83%, 100%) and 3.6 mSv (95% CI 2.9, 4.3 mSv), respectively. Both quantitative and qualitative assessments of image quality indicated that image quality was achieved in studies using prospective ECG-triggered CCTA, regardless of the type of CT scanners. The pooled es...

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“…(2,(5)(6)(7)(8)(9)14,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) The attrition diagram for our study depicting the search process is shown in Fig. 2 Table III.…”

Section: Resultsmentioning

confidence: 99%

Coronary computed tomography angiography with prospective electrocardiography triggering: a systematic review of image quality and radiation dose

Sabarudin

Sun

2013

SMedJ

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“…Arnoldi et al (15) demonstrated that when using prospective scanning, the required radiation dose is 2.8 mSv, which is markedly lower than the retrospective scanning dose of 18.4 mSv. A prospective series scan is a step-axis scanning mode, Table II.…”

Section: Discussionmentioning

confidence: 99%

Dose study of electrocardiogram automatic tube current modulation technology in prospective coronary computed tomography angiography scans of overweight patients

Liu

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the X-ray absorption dose and clinical applications of electrocardiogram (ECG)-gated automatic tube current modulation (ATCM) technology in prospective sequential computed tomography coronary angiography (CTCA) scans of overweight patients. A total of 40 patients with a body mass index of >24 were divided at random into groups A and B. Group A consisted of 20 patients, who were examined using ECG-ATCM scanning. For the patients in group A with heart rates <70 bpm, the scanning range was 20-80% of the R-R interval and the patients received full-dose X-rays for 60-80% of the R-R interval. For the group A patients with heart rates >70 bpm, the scanning range was 20-80% of the R-R interval and the patients received full-dose scanning for 35-55% of the R-R interval. For the 20 patients in group B, the scanning range was 20-80% of the R-R interval and patients received a full dose of X-ray radiation for the entire scanning period. The image quality and radiation dose was compared between the two groups. The average radiation dose in groups A and B was 6.91±2.78 and 10.43±3.36, respectively. The radiation doses in group A were reduced by 33.77% when compared with group B (P<0.05). However, there was no marked difference observed in image quality. In summary, using ECG-ATCM technology in prospective sequential CTCA scanning may significantly reduce the radiation dose required for overweight patients.

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“…There are two levels of ECG-controlled tube current modulation available, whereby the tube output can be reduced to 25% or 4% (min-dose, Siemens Healthcare, Forchheim, Germany) outside the predefined temporal window [7,8,20]. The former (i.e.…”

Section: Imaging Techniquementioning

confidence: 99%

“…It is advocated when performing cardiovascular CT on children with heart rate above 80 bpm, that data is acquired at end-systole using an absolute (ms) trigger delay as opposed to a relative (percentage) trigger delay [8,[18][19][20] to ensure maximum image quality. This will also help minimise stair-step artefact.…”

Section: Imaging Techniquementioning

confidence: 99%

“…However the increase in radiation burden associated with retrospective ECG-gating has been a limiting factor that has reduced uptake in paediatrics. Conversely the use of prospective ECG-gating with its much reduced radiation dose, has always been confined to adult patients with low heart rates [7], with studies demonstrating no significant difference in image quality or coronary artery detection rate between prospective and retrospective ECG-gated imaging [8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Paediatric cardiac computed tomography: a review of imaging techniques and radiation dose consideration

Young

Owens²

2010

Eur Radiol

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The significant challenges involved in imaging the heart in small children (<15 kg) have been addressed by, and partially resolved with improvement in temporal and spatial resolution secondary to the advent of new multidetector CT technology. This has enabled both retrospective and prospective ECG-gated imaging in children even at high heart rates (over 100 bpm) without the need for beta blockers. Recent studies have highlighted that the radiation burden associated with cardiac CT can be reduced using prospective ECG-gating. Our experience shows that the resultant dose reduction can be optimised to a level equivalent to that of a non-gated study. This article reviews the different aspects of ECG-gating and the preferred technique for cardiac imaging in the young child (<15 kg). We summarize our evidenced based recommendations for readers, referencing recent articles and using our in house data, protocols and dose measurements discussing the various methods available for dose calculations and their inherent bias.

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Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques

Cited by 62 publications

References 35 publications

Coronary computed tomography angiography with prospective electrocardiography triggering: a systematic review of image quality and radiation dose

Coronary computed tomography angiography with prospective electrocardiography triggering: a systematic review of image quality and radiation dose

Dose study of electrocardiogram automatic tube current modulation technology in prospective coronary computed tomography angiography scans of overweight patients

Paediatric cardiac computed tomography: a review of imaging techniques and radiation dose consideration

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