Evaluation of a Tube Voltage–Tailored Contrast Medium Injection Protocol for Coronary CT Angiography: Results From the Prospective VOLCANIC Study

Martin, Simon S.; Giovagnoli, Dante A; Abadia, Andres F.; Vingiani, Vincenzo; Doeberitz, Philipp L. von Knebel; Smith, Hubert E; Fischer, Andreas; Varga-Szemes, Ákos; Vogl, Thomas J.; Cecco, Carlo N. De; Schoepf, U. Joseph

doi:10.2214/ajr.20.22777

Cited by 8 publications

(14 citation statements)

References 27 publications

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“…In doing so, it complements the results of the volcanic study, which recently demonstrated for CT coronary angiography the CM savings that can be achieved by kV adjustments in 10-kV steps at constant CNR [ 12 ]. Nevertheless, it also highlights the nonlinear correlation between noise and radiation dose [ 22 ].…”

Section: Discussionsupporting

confidence: 54%

Individualized scan protocols for CT angiography: an animal study for contrast media or radiation dose optimization

et al. 2023

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Background We investigated about optimization of contrast media (CM) dose or radiation dose in thoracoabdominal computed tomography angiography (CTA) by automated tube voltage selection (ATVS) system configuration and CM protocol adaption. Methods In six minipigs, CTA-optimized protocols were evaluated regarding objective (contrast-to-noise ratio, CNR) and subjective (6 criteria assessed by Likert scale) image quality. Scan parameters were automatically adapted by the ATVS system operating at 90-kV semi-mode and configured for standard, CM saving, or radiation dose saving (image task, quality settings). Injection protocols (dose, flow rate) were adapted manually. This approach was tested for normal and simulated obese conditions. Results Radiation exposure (volume-weighted CT dose index) for normal (obese) conditions was 2.4 ± 0.7 (5.0 ± 0.7) mGy (standard), 4.3 ± 1.1 (9.0 ± 1.3) mGy (CM reduced), and 1.7 ± 0.5 (3.5 ± 0.5) mGy (radiation reduced). The respective CM doses for normal (obese) settings were 210 (240) mgI/kg, 155 (177) mgI/kg, and 252 (288) mgI/kg. No significant differences in CNR (normal; obese) were observed between standard (17.8 ± 3.0; 19.2 ± 4.0), CM-reduced (18.2 ± 3.3; 20.5 ± 4.9), and radiation-saving CTAs (16.0 ± 3.4; 18.4 ± 4.1). Subjective analysis showed similar values for optimized and standard CTAs. Only the parameter diagnostic acceptability was significantly lower for radiation-saving CTA compared to the standard CTA. Conclusions The CM dose (-26%) or radiation dose (-30%) for thoracoabdominal CTA can be reduced while maintaining objective and subjective image quality, demonstrating the feasibility of the personalization of CTA scan protocols. Key points • Computed tomography angiography protocols could be adapted to individual patient requirements using an automated tube voltage selection system combined with adjusted contrast media injection. • Using an adapted automated tube voltage selection system, a contrast media dose reduction (-26%) or radiation dose reduction (-30%) could be possible

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Section: Discussionsupporting

confidence: 54%

Individualized scan protocols for CT angiography: an animal study for contrast media or radiation dose optimization

et al. 2023

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“…Besides the use of test bolus, some studies use tailored CM protocols with (automatic) bolus tracking. Martin et al [ 23 ] evaluated the feasibility of a vendor’s software using a tube voltage-tailored CM application, which still resulted in more than 25% of the CTAs with attenuations in the ascending aorta below 400 HU. In another study with bolus tracking, Yin et al [ 24 ] evaluated protocols tailored for BMI or BSA, and, either way, cases of insufficient attenuation in the aorta occurred.…”

Section: Discussionmentioning

confidence: 99%

Machine learning-based prediction of insufficient contrast enhancement in coronary computed tomography angiography

et al. 2022

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Objectives Patient-tailored contrast delivery protocols strongly reduce the total iodine load and in general improve image quality in CT coronary angiography (CTCA). We aim to use machine learning to predict cases with insufficient contrast enhancement and to identify parameters with the highest predictive value. Methods Machine learning models were developed using data from 1,447 CTs. We included patient features, imaging settings, and test bolus features. The models were trained to predict CTCA images with a mean attenuation value in the ascending aorta below 400 HU. The accuracy was assessed by the area under the receiver operating characteristic (AUROC) and precision-recall curves (AUPRC). Shapley Additive exPlanations was used to assess the impact of features on the prediction of insufficient contrast enhancement. Results A total of 399 out of 1,447 scans revealed attenuation values in the ascending aorta below 400 HU. The best model trained using only patient features and CT settings achieved an AUROC of 0.78 (95% CI: 0.73–0.83) and AUPRC of 0.65 (95% CI: 0.58–0.71). With the inclusion of the test bolus features, it achieved an AUROC of 0.84 (95% CI: 0.81–0.87), an AUPRC of 0.71 (95% CI: 0.66–0.76), and a sensitivity of 0.66 and specificity of 0.88. The test bolus’ peak height was the feature that impacted low attenuation prediction most. Conclusion Prediction of insufficient contrast enhancement in CT coronary angiography scans can be achieved using machine learning models. Our experiments suggest that test bolus features are strongly predictive of low attenuation values and can be used to further improve patient-specific contrast delivery protocols. Key Points • Prediction of insufficient contrast enhancement in CT coronary angiography scans can be achieved using machine learning models. • The peak height of the test bolus curve is the most impacting feature for the best performing model.

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“…For the control group, the dosage of contrast agent was set according to body mass (< 50 kg, 32 ml; 50–59 kg, 36 ml; 60–69 kg, 40 ml; 70–79 kg, 45 ml; ≥ 80 kg, 50 ml), and injection time was 12 s. Patients in the observation group used the automatic tube voltage selection technology to set the dosage of contrast agent (70 kV, 33 ml; 80 kV, 36 ml; 90 kV, 42 ml; 100 kV, 46 ml; 110 kV, 52 ml; 120 kV, 55 ml), and injection time was 10 s ( 5 ). All the patients' images were transmitted to the image post-processing workstation (Siemens Healthcare, Forchheim, Germany), and multi-planar reformation (MPR), volume rendering (VR), and curved planar reformation (CPR) were performed for image reconstruction and post-processing.…”

Section: Methodsmentioning

confidence: 99%

Influence of Contrast Agent Injection Scheme Customized by Dual-Source CT Based on Automatic Tube Voltage Technology on Image Quality and Radiation Dose of Coronary Artery Imaging

Chen

et al. 2022

Front. Surg.

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ObjectiveTo explore the influence of a contrast agent injection scheme customized by dual-source CT based on automatic tube voltage technology on coronary imaging image quality and radiation dose.MethodsA total of 205 patients who underwent coronary CT angiography (CCTA) in our hospital from June 2021 to September 2021 were selected. 105 patients in the control group who underwent routine scanning according to body mass (BMI) and 100 patients in the observation group who set tube voltage and contrast agent dosage according to automatic tube voltage selection technology. CT values of the aortic root (AO); left anterior descending (LAD) branch; proximal, middle, and distal segments of the right coronary artery (RCA); and proximal and distal segments of left circumflex (LCX) branch were measured. We calculated the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the image. Image quality scoring and effective dose (ED) calculation were carried out.ResultsThere was no significant difference in the CT value, SNR value, and CNR value of each part of the artery between the two groups (P > 0.05). Image quality scores of the control group and the observation group were 1.28 ± 0.25 and 1.25 ± 0.23, respectively, and there was no significant difference in scores (P > 0.05). In the control group, the dosage of comparator was 43.81 ± 6.74 ml, and the ED was 4.92 ± 1.26 mSv. The dosage of contrast agent in the observation group was 34.23 ± 6.39 ml, and ED was 3.05 ± 0.94 mSv. The dosage of contrast agent and ED in the observation group were lower than those in the control group (P < 0.05).ConclusionThe contrast agent injection scheme customized by dual-source CT based on automatic tube voltage technology can meet the clinical requirements of coronary image quality, reduce the radiation dose and contrast agent consumption, and help doctors choose a more accurate and reasonable examination scheme, which has certain clinical application value.

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Evaluation of a Tube Voltage–Tailored Contrast Medium Injection Protocol for Coronary CT Angiography: Results From the Prospective VOLCANIC Study

Cited by 8 publications

References 27 publications

Individualized scan protocols for CT angiography: an animal study for contrast media or radiation dose optimization

Individualized scan protocols for CT angiography: an animal study for contrast media or radiation dose optimization

Machine learning-based prediction of insufficient contrast enhancement in coronary computed tomography angiography

Influence of Contrast Agent Injection Scheme Customized by Dual-Source CT Based on Automatic Tube Voltage Technology on Image Quality and Radiation Dose of Coronary Artery Imaging

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