Lower Radiation Dosing in Cardiac CT Angiography: The CONVERGE Registry

Madaj, Paul; Li, Dong; Nakanishi, Rine; Andreini, Daniele; Conte, Edoardo; Franzcr, Rachael O’Rourke; Hamilton-Craig, C.; Nimmagadda, Manojna; Kim, Nicholas; Fatima, Badiha; Dailing, Christopher; Budoff, Matthew J.

doi:10.2967/jnmt.119.229500

Cited by 7 publications

(3 citation statements)

References 32 publications

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“…The CONVERGE study compared groups of 110 patients using 64-slice and 256slice cameras in each group. The determined mean DLP values in the group tested using the 256-slice instrument (Revolution CT, GE Healthcare) were 113.5 ± 53.6 3 mGy*cm (1.59 ± 0.75 mSv) and were 32% lower than the group tested using the 64-slice instrument for the patients with normal BMI values (18.5-24.9) [56].…”

Section: Multi-slice Dual-source and Wide-field Tomographymentioning

confidence: 81%

Radiation Doses in Cardiovascular Computed Tomography

Kȩdzierski¹,

Macek

Dziadkowiec-Macek

et al. 2023

Life

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We discussed the contemporary views on the effects of ionising radiation on living organisms and the process of estimating radiation doses in CT examinations and the definitions of the CTDI, CTDIvol, DLP, SSDE, ED. We reviewed the reports from large analyses on the radiation doses in CT examinations of the coronary arteries prior to TAVI procedures, including the CRESCENT, PROTECTION, German Cardiac CT Registry studies. These studies were carried out over the last 10 years and can help confront the daily practice of performing cardiovascular CT examinations in most centres. The reference dose levels for these examinations were also collected. The methods to optimise the radiation dose included tube voltage reduction, ECG-monitored tube current modulation, iterative and deep learning reconstruction techniques, a reduction in the scan range, prospective study protocols, automatic exposure control, heart rate control, rational use of the calcium score, multi-slices and dual-source and wide-field tomography. We also present the studies that indicated the need to raise the organ conversion factor for cardiovascular studies from the 0.014–0.017 mSv/mGy*cm used for chest studies to date to a value of 0.0264–0.03 mSv/mGy*cm.

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Section: Multi-slice Dual-source and Wide-field Tomographymentioning

confidence: 81%

Radiation Doses in Cardiovascular Computed Tomography

Kȩdzierski¹,

Macek

Dziadkowiec-Macek

et al. 2023

Life

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“…As mentioned above, better delimitation of the scan range is not the only way to reduce radiation exposure [ 28 – 30 ]. Hausleiter et al identified several factors influencing the radiation dose in CCTAs [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Deep learning–based scan range optimization can reduce radiation exposure in coronary CT angiography

et al. 2023

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Objectives Cardiac computed tomography (CT) is essential in diagnosing coronary heart disease. However, a disadvantage is the associated radiation exposure to the patient which depends in part on the scan range. This study aimed to develop a deep neural network to optimize the delimitation of scan ranges in CT localizers to reduce the radiation dose. Methods On a retrospective training cohort of 1507 CT localizers randomly selected from calcium scoring and angiography scans and acquired between 2010 and 2017, optimized scan ranges were delimited by two radiologists in consensus. A neural network was trained to reproduce the scan ranges and was tested on two randomly selected and independent validation cohorts: an internal cohort of 233 CT localizers (January 2018–June 2020) and an external cohort from a nearby hospital of 298 CT localizers (July 2020–December 2020). Localizers where a bypass surgery was visible were excluded. The effective radiation dose to the patient was simulated using a Monte Carlo simulation. Scan ranges of radiographers, radiologists, and the network were compared using an equivalence test; likewise, the reduction in effective dose was tested using a superior test. Results The network replicated the radiologists’ scan ranges with a Dice score of 96.5 ± 0.02 (p < 0.001, indicating equivalence). The generated scan ranges resulted in an effective dose reduction of 10.0% (p = 0.002) in the internal cohort and 12.6% (p < 0.001) in the external cohort compared to the scan ranges delimited by radiographers in clinical routine. Conclusions Automatic delimitation of the scan range can result in a radiation dose reduction to the patient. Clinical relevance statement Fully automated delimitation of the scan range using a deep neural network enables a significant reduction in radiation exposure during CT coronary angiography compared to manual examination planning. It can also reduce the workload of the radiographers. Key Points • Scan range delimitation for coronary computed tomography angiography could be performed with high accuracy by a deep neural network. • Automated scan ranges showed a high agreement of 96.5% with the scan ranges of radiologists. • Using a Monte Carlo simulation, automated scan ranges reduced the effective dose to the patient by up to 12.6% (0.9 mSv) compared to the scan ranges of radiographers in clinical routine. Graphical abstract

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“…Moreover, detailed plaque burden quantification and characterisation, though use of automated and semi-automated software, is still time-consuming, and hardly implemented in daily routine. However, thanks to technical developments, radiation exposure has been dramatically reduced, from 5-6 mSv to an average of 1-2 mSv [78], and overestimation of vessel stenoses, mainly due to calcific burden, has been reduced [79].…”

Section: Cardiac Computed Tomography Angiography and Plaque Imagingmentioning

confidence: 99%

Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging

Baggiano

Italiano

Guglielmo

et al. 2022

JCM

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Coronary artery disease (CAD) represents the most common cardiovascular disease, with high morbidity and mortality. Historically patients with chest pain of suspected coronary origin have been assessed with functional tests, capable to detect haemodynamic consequences of coronary obstructions through depiction of electrocardiographic changes, myocardial perfusion defects or regional wall motion abnormalities under stress condition. Stress echocardiography (SE), single-photon emission computed tomography (SPECT), positron emission tomography (PET) and cardiovascular magnetic resonance (CMR) represent the functional techniques currently available, and technical developments contributed to increased diagnostic performance of these techniques. More recently, cardiac computed tomography angiography (cCTA) has been developed as a non-invasive anatomical test for a direct visualisation of coronary vessels and detailed description of atherosclerotic burden. Cardiovascular imaging techniques have dramatically enhanced our knowledge regarding physiological aspects and myocardial implications of CAD. Recently, after the publication of important trials, international guidelines recognised these changes, updating indications and level of recommendations. This review aims to summarise current standards with main novelties and specific limitations, and a diagnostic algorithm for up-to-date clinical management is also proposed.

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Lower Radiation Dosing in Cardiac CT Angiography: The CONVERGE Registry

Cited by 7 publications

References 32 publications

Radiation Doses in Cardiovascular Computed Tomography

Radiation Doses in Cardiovascular Computed Tomography

Deep learning–based scan range optimization can reduce radiation exposure in coronary CT angiography

Changing Paradigms in the Diagnosis of Ischemic Heart Disease by Multimodality Imaging

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