High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction

Apfaltrer, Georg; Albrecht, Moritz H.; Schoepf, U. Joseph; Duguay, Taylor M.; Cecco, Carlo N. De; Nance, John W.; Santis, Domenico De; Apfaltrer, Paul; Eid, Marwen; Eason, Chelsea; Thompson, Zachary M; Bauer, Maximilian J.; Varga-Szemes, Ákos; Jacobs, Brian E.; Sorantin, Erich; Tesche, Christian

doi:10.1007/s00330-017-5249-2

Cited by 36 publications

(30 citation statements)

References 18 publications

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“…Technological developments like tin filtration and automated tube voltage selection allow for a substantial dose reduction. For example, a 100 kVp with tin filtration CACS protocol demonstrated similar Agatston scores as the reference protocol with 120 kVp despite using the standard reconstruction technique [18]. Larger deviations are expected for tube voltages like 70 and 80 kVp ( Table 2).…”

Section: Discussionmentioning

confidence: 92%

Dose reduction for CT coronary calcium scoring with a calcium-aware image reconstruction technique: a phantom study

et al. 2020

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Objective To assess the dose reduction potential of a calcium-aware reconstruction technique, which aims at tube voltageindependent computed tomography (CT) numbers for calcium. Methods and materials A cardiothoracic phantom, mimicking three different patient sizes, was scanned with two calcium inserts (named D100 and CCI), containing calcifications varying in size and density. Tube voltage was varied both manually (range 70-150 and Sn100 kVp) and automatically. Tube current was automatically adapted to maintain reference image quality defined at 120 kVp. Data was reconstructed with the standard reconstruction technique (kernel Qr36) and the calcium-aware reconstruction technique (kernel Sa36). We assessed the radiation dose reduction potential (volumetric CT dose index values (CTDIvol)), noise (standard deviation (SD)), mean CT number (HU) of each calcification, and Agatston scores for varying kVp. Results were compared with the reference acquired at 120 kVp and reconstructed with Qr36. Results Automatic selection of the optimal tube voltage resulted in a CTDIvol reduction of 22%, 15%, and 12% compared with the reference for the small, medium, and large phantom, respectively. CT numbers differed up to 64% for the standard reconstruction and 11% for the calcium-aware reconstruction. Similarly, Agatston scores deviated up to 40% and 8% for the standard and calcium-aware reconstruction technique, respectively. Conclusion CT numbers remained consistent with comparable calcium scores when the calcium-aware image reconstruction technique was applied with varying tube voltage. Less consistency was observed in small calcifications with low density. Automatic reduction of tube voltage resulted in a dose reduction of up to 22%. Key Points • The calcium-aware image reconstruction technique allows for consistent CT numbers when varying the tube voltage. • Automatic reduction of tube voltage results in a reduced radiation exposure of up to 22%. • This study stresses the known limitations of the current Agatston score technique. Keywords Computed x-ray tomography. Coronary artery disease. Radiation dosage. Diagnostic imaging Abbreviations ATCM Automated tube current modulation BAS Background Agatston score CACS Coronary artery calcium scoring CI Confidence interval CNR Contrast to noise ratio CT Computed tomography CTDI Computed tomography dose index DSCT Dual source computed tomography Dw Water equivalent diameter FBP Filtered back projection FoV Field of view HU Hounsfield unit ICC Intraclass correlation coefficient SD Standard deviation Electronic supplementary material The online version of this article (

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Section: Discussionmentioning

confidence: 92%

Dose reduction for CT coronary calcium scoring with a calcium-aware image reconstruction technique: a phantom study

et al. 2020

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“…Non-contrast-enhanced, ECG-triggered, coronary calcium scoring computed tomography (CSCT) detects coronary artery calcifications (CAC) at low radiation doses [1] and is reliable in predicting future cardiovascular (CV) events for asymptomatic patients, independent of conventional risk models [2]. Clinical guidelines in the USA [3,4] and Europe [5] recommend CSCT in selected asymptomatic individuals, typically with an intermediate probability in a pre-test, clinical CV risk assessment.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of an AI-based, automatic coronary artery calcium scoring software

et al. 2019

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Objectives To evaluate an artificial intelligence (AI)-based, automatic coronary artery calcium (CAC) scoring software, using a semi-automatic software as a reference. Methods This observational study included 315 consecutive, non-contrast-enhanced calcium scoring computed tomography (CSCT) scans. A semi-automatic and an automatic software obtained the Agatston score (AS), the volume score (VS), the mass score (MS), and the number of calcified coronary lesions. Semi-automatic and automatic analysis time were registered, including a manual double-check of the automatic results. Statistical analyses were Spearman's rank correlation coefficient (⍴), intra-class correlation (ICC), Bland Altman plots, weighted kappa analysis (κ), and Wilcoxon signed-rank test. Results The correlation and agreement for the AS, VS, and MS were ⍴ = 0.935, 0.932, 0.934 (p < 0.001), and ICC = 0.996, 0.996, 0.991, respectively (p < 0.001). The correlation and agreement for the number of calcified lesions were ⍴ = 0.903 and ICC = 0.977 (p < 0.001), respectively. The Bland Altman mean difference and 1.96 SD upper and lower limits of agreements for the AS, VS, and MS were − 8.2 (− 115.1 to 98.2), − 7.4 (− 93.9 to 79.1), and − 3.8 (− 33.6 to 25.9), respectively. Agreement in risk category assignment was 89.5% and κ = 0.919 (p < 0.001). The median time for the semi-automatic and automatic method was 59 s (IQR 35-100) and 36 s (IQR 29-49), respectively (p < 0.001). Conclusions There was an excellent correlation and agreement between the automatic software and the semi-automatic software for three CAC scores and the number of calcified lesions. Risk category classification was accurate but showing an overestimation bias tendency. Also, the automatic method was less time-demanding. Key Points • Coronary artery calcium (CAC) scoring is an excellent candidate for artificial intelligence (AI) development in a clinical setting. • An AI-based, automatic software obtained CAC scores with excellent correlation and agreement compared with a conventional method but was less time-consuming.

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“…The current method for CAC scoring is the acquisition of a 120 kVp non-contrast-enhanced, prospective ECG-triggered cardiac CT [ 13 - 14 ]. Images obtained can then be used to evaluate the extent of calcification and assign a quantity-based total called the Agatston score determined by lesion area in square millimeters and the maximal CT Hounsfield unit [ 13 , 28 ].…”

Section: Reviewmentioning

confidence: 99%

“…A prior study by Shemesh et al demonstrated that a CAC score of 4 or greater is a significant predictor of cardiovascular death (odds ratio 4.7, P < .0001) [ 12 ]. The use of CAC as a marker for the presence of coronary artery atherosclerosis has traditionally been quantified with dedicated cardiac CT using an electrocardiogram (ECG)-gated technique [ 13 - 14 ]. Emerging evidence suggests that CAC can be accurately assessed on non-ECG gated CT as well as LDCT.…”

Section: Introductionmentioning

confidence: 99%

The Future of Concurrent Automated Coronary Artery Calcium Scoring on Screening Low-Dose Computed Tomography

Waltz

Kocher

Kahn

et al. 2020

Cureus

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Low-dose computed tomography (LDCT) has been extensively validated for lung cancer screening in selected patient populations. Additionally, the use of gated cardiac CT to assess coronary artery calcium (CAC) burden has been validated to determine a patient's risk for major cardiovascular adverse events. This is typically performed by calculating an Agatston score based on density and overall burden of calcified plaque within the coronary arteries. Patients that qualify for LDCT for lung cancer screening commonly share major risk factors for coronary artery disease and would frequently benefit from an additional gated cardiac CT for the assessment of CAC. Given the widespread use of LDCT for lung cancer screening, we evaluated current literature regarding the use of non-gated chest CT, specifically LDCT, for the detection and grading of coronary artery calcifications. Additionally, given the evolving and increasing use of artificial intelligence (AI) in the interpretation of radiologic studies, current literature for the use of AI in CAC assessment was reviewed.

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High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction

Cited by 36 publications

References 18 publications

Dose reduction for CT coronary calcium scoring with a calcium-aware image reconstruction technique: a phantom study

Dose reduction for CT coronary calcium scoring with a calcium-aware image reconstruction technique: a phantom study

Evaluation of an AI-based, automatic coronary artery calcium scoring software

The Future of Concurrent Automated Coronary Artery Calcium Scoring on Screening Low-Dose Computed Tomography

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