Effect of a Standardized Radiation Dose Reduction Protocol on Diagnostic Accuracy of Coronary Computed Tomographic Angiography

LaBounty, Troy; Leipsic, Jonathon; Mancini, G.B. John; Heilbron, Brett; Patel, Smita; Kazerooni, Ella A.; Sundaram, Baskaran; Lin, Fay Y.; Dunning, Allison; Saltzman, Adam J.; Weisz, Giora; Weinsaft, Jonathan W.; Choi, Jin Ho; Koduru, Sunaina; Min, James K.

doi:10.1016/j.amjcard.2010.02.038

Cited by 21 publications

(11 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…10 Furthermore, standard low tube potential imaging is limited to patients with smaller body habitus. 11,12 This is a particular limitation when it comes to evaluating pulmonary pathology in patients with undifferentiated chest pain.…”

Section: Discussionmentioning

confidence: 99%

Reduced iodine load with CT coronary angiography using dual-energy imaging: A prospective randomized trial compared with standard coronary CT angiography

Raju

Thompson

Lee

et al. 2014

Journal of Cardiovascular Computed Tomography

Self Cite

View full text Add to dashboard Cite

Background There is concern regarding the administration of iodinated contrast to patients with impaired renal function because of the increased risk of contrast-induced nephropathy. Objective Evaluate image quality and feasibility of a protocol with a reduced volume of iodinated contrast and utilization of dual-energy coronary CT angiography (DECT) vs a standard iodinated contrast volume coronary CT angiography protocol (SCCTA). Methods A total of 102 consecutive patients were randomized to SCCTA (n = 53) or DECT with rapid kVp switching (n = 49). Eighty milliliters and 35 mL of iodinated contrast were administered in the SCCTA and DECT cohorts, respectively. Two readers measured signal and noise in the coronary arteries; signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were calculated. A 5-point signal/noise Likert scale was used to evaluate image quality; scores of <3 were nondiagnostic. Agreement was assessed through kappa analyses. Results Demographics and radiation dose were not significantly different; there was no difference in CNR between both cohorts (P = .95). A significant difference in SNR between the groups (P = .02) lost significance (P = .13) when adjusted for body mass index. The median Likert score was inferior for DECT for reader 1 (3.6 ± 0.6 vs 4.3 ± 0.6; P < .001) but not reader 2 (4.1 ± 0.6 vs 4.3 ± 0.5; P = .06). Agreement in diagnostic interpretability in the DECT and SCCTA groups was 91% (95% confidence interval, 86%–100%) and 96% (95% confidence interval, 90%–100%), respectively. Conclusion DECT resulted in inferior image quality scores but demonstrated comparable SNR, CNR, and rate of diagnostic interpretability without a radiation dose penalty while allowing for >50% reduction in contrast volume compared with SCCTA.

show abstract

Section: Discussionmentioning

confidence: 99%

Reduced iodine load with CT coronary angiography using dual-energy imaging: A prospective randomized trial compared with standard coronary CT angiography

Raju

Thompson

Lee

et al. 2014

Journal of Cardiovascular Computed Tomography

Self Cite

View full text Add to dashboard Cite

show abstract

“…The details of those studies have been previously published, including reported approval from the institutional review boards at all sites. 2,5 Both studies were performed in symptomatic patients referred for invasive coronary angiography for suspected CAD. In both studies, all adult patients (age R18 years) were included regardless of body mass index.…”

Section: Methodsmentioning

confidence: 99%

What is the optimal number of readers needed to achieve high diagnostic accuracy in coronary computed tomographic angiography? A comparison of alternate reader combinations

LaBounty

Leipsic

Srichai

et al. 2010

Journal of Cardiovascular Computed Tomography

Self Cite

View full text Add to dashboard Cite

“…However, selective combined use of these techniques when appropriate offers the greatest potential for dose reduction. Recently, LaBounty et al 101,102 compared the use of nonstandard and standardized CCTA imaging protocols at 3 sites. Standardized protocols took into account patient heart rate, BMI, and clinical indications to systematically dictate the use of prospective triggering (versus retrospective gating), tube voltage, tube current, padding duration, and ECG-based tube current modulation.…”

Section: Development Of Standardized Protocolsmentioning

confidence: 99%

Optimization of Radiation Dose Reduction in Cardiac Computed Tomographic Angiography

Entrikin

Leipsic²,

Carr³

2011

Cardiology in Review

View full text Add to dashboard Cite

Cardiac computed tomographic angiography (CCTA) has evolved at an unprecedented pace over the past decade, during which time it has proven to be an accurate and effective tool for imaging of the heart in a growing list of clinical applications. However, the rapid growth in the use of CT imaging in general has prompted appropriate concerns regarding increasing medical radiation exposure to patients, particularly with regard to potential long-term risks of radiation-induced malignancy on both individual and population levels. As with all medical imaging modalities, imaging the heart with CCTA should be performed in a manner that achieves diagnostic image quality while maintaining patient radiation exposure as low as reasonably achievable (As Low As Reasonably Achievable [ALARA] principle). The goal of this article is to provide the reader with a wide-ranging review of both primary and secondary techniques that are currently available to minimize patient radiation exposure. Some of the techniques described in this article are universal, whereas others may be scanner specific. By gaining a thorough understanding of the various tools and methodologies employed for reduction of radiation exposure, the cardiac imager should be able to formulate CCTA protocols appropriate for their equipment and their clinical applications, in a manner that optimally preserves diagnostic image quality and minimizes patient radiation dose.

show abstract

Effect of a Standardized Radiation Dose Reduction Protocol on Diagnostic Accuracy of Coronary Computed Tomographic Angiography

Cited by 21 publications

References 17 publications

Reduced iodine load with CT coronary angiography using dual-energy imaging: A prospective randomized trial compared with standard coronary CT angiography

Reduced iodine load with CT coronary angiography using dual-energy imaging: A prospective randomized trial compared with standard coronary CT angiography

What is the optimal number of readers needed to achieve high diagnostic accuracy in coronary computed tomographic angiography? A comparison of alternate reader combinations

Optimization of Radiation Dose Reduction in Cardiac Computed Tomographic Angiography

Contact Info

Product

Resources

About