Circulation. 2006;113:1305-1310
Published online before print March 6, 2006, doi: 10.1161/CIRCULATIONAHA.105.602490
Published online before print March 6, 2006, doi: 10.1161/CIRCULATIONAHA.105.602490
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2006;113:1305-1310.)
© 2006 American Heart Association, Inc.
Imaging |
Radiation Dose Estimates From Cardiac Multislice Computed Tomography in Daily Practice
Impact of Different Scanning Protocols on Effective Dose Estimates
From Klinik für Herz- und Kreislauferkrankungen (J.H., M.H., A.K., A.S.) and Institut für Radiologie und Nuklearmedizin (T.M., E.H., S.M.), Deutsches Herzzentrum München, Klinik an der TU München, Munich, Germany; and Institut für Strahlenschutz (M.Z.), GSF-Forschungszentrum für Umwelt und Gesundheit, Neuherberg, Germany.
Correspondence to Dr Jörg Hausleiter, Deutsches Herzzentrum, Lazarettstrasse 36, 80636 München, Germany. E-mail hausleiter{at}dhm.mhn.de
Received August 22, 2005; de novo received November 18, 2005; revision received January 5, 2006; accepted January 6, 2006.
Background— Multislice computed tomography angiography (CTA) is a promising technology for imaging patients with suspected coronary artery disease. Compared with 16-slice CTA, the improved spatial and temporal resolution of 64-slice CTA (0.6- versus 1.0-mm slice thickness and 330- versus 420-ms gantry rotation time) is associated with an increase in radiation dose. The objective of this retrospective investigation was to compare the estimated dose received during 16- and 64-slice CTA in daily practice and to investigate the impact of different scan protocols on dose and image quality.
Methods and Results— Radiation dose was estimated for 1035 patients undergoing coronary CTA. Scanning algorithms with and without an ECG-dependent dose modulation and with a reduced tube voltage were investigated on dose estimates and image quality. In the entire patient cohort, radiation dose estimates were 6.4±1.9 and 11.0±4.1 mSv for 16- and 64-slice CTA, respectively (P<0.01). The reduction in radiation dose estimates ranged between 37% and 40% and between 53% and 64% with the use of ECG-dependent dose modulation and with the combined use of the dose modulation and a reduced tube voltage, respectively. The reduction in dose estimates was not associated with a reduction in diagnostic image quality as assessed by the signal-to-noise ratio and by the frequency of coronary segments with diagnostic image quality.
Conclusions— The increase in spatial and temporal resolution with 64-slice CTA is associated with an increased radiation dose for coronary CTA. Dose-saving algorithms are very effective in reducing radiation exposure and should be used whenever possible.
CLINICAL PERSPECTIVE
This article has been cited by other articles:
 |
|
 |
|
  S. Baumuller, S. Leschka, L. Desbiolles, P. Stolzmann, H. Scheffel, B. Seifert, B. Marincek, and H. Alkadhi Dual-Source versus 64-Section CT Coronary Angiography at Lower Heart Rates: Comparison of Accuracy and Radiation Dose Radiology, July 8, 2009; (2009) 2531090065. [Abstract] [Full Text]
|
|
|
|
 |
|
 C. Fujioka, J. Horiguchi, M. Kiguchi, H. Yamamoto, T. Kitagawa, and K. Ito Survey of Aorta and Coronary Arteries With Prospective ECG-Triggered 100-kV 64-MDCT Angiography Am. J. Roentgenol., July 1, 2009; 193(1): 227 - 233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. C. Weustink, N. R. Mollet, L. A. Neefjes, M. van Straten, E. Neoh, S. Kyrzopoulos, B. W. Meijboom, C. van Mieghem, F. Cademartiri, P. J. de Feyter, et al. Preserved Diagnostic Performance of Dual-Source CT Coronary Angiography with Reduced Radiation Exposure and Cancer Risk Radiology, July 1, 2009; 252(1): 53 - 60. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. van Werkhoven, J. D. Schuijf, O. Gaemperli, J. W. Jukema, L. J. Kroft, E. Boersma, A. Pazhenkottil, I. Valenta, G. Pundziute, A. de Roos, et al. Incremental prognostic value of multi-slice computed tomography coronary angiography over coronary artery calcium scoring in patients with suspected coronary artery disease Eur. Heart J., June 29, 2009; (2009) ehp272v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. L. Raff, K. M. Chinnaiyan, D. A. Share, T. Y. Goraya, E. A. Kazerooni, M. Moscucci, R. E. Gentry, A. Abidov, and for the Advanced Cardiovascular Imaging Consortium Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose-Reduction Techniques JAMA, June 10, 2009; 301(22): 2340 - 2348. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Takakuwa, E. J. Halpern, E. L. Gingold, D. C. Levin, and F. S. Shofer Radiation Dose in a "Triple Rule-Out" Coronary CT Angiography Protocol of Emergency Department Patients Using 64-MDCT: The Impact of ECG-Based Tube Current Modulation on Age, Sex, and Body Mass Index Am. J. Roentgenol., April 1, 2009; 192(4): 866 - 872. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Pflederer, L. Rudofsky, D. Ropers, S. Bachmann, M. Marwan, W. G. Daniel, and S. Achenbach Image Quality in a Low Radiation Exposure Protocol for Retrospectively ECG-Gated Coronary CT Angiography Am. J. Roentgenol., April 1, 2009; 192(4): 1045 - 1050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Husmann, B. A. Herzog, O. Gaemperli, F. Tatsugami, N. Burkhard, I. Valenta, P. Veit-Haibach, C. A. Wyss, U. Landmesser, and P. A. Kaufmann Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating Eur. Heart J., March 1, 2009; 30(5): 600 - 607. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Tatsugami, L. Husmann, B. A. Herzog, N. Burkhard, I. Valenta, O. Gaemperli, and P. A. Kaufmann Evaluation of a Body Mass Index-Adapted Protocol for Low-Dose 64-MDCT Coronary Angiography with Prospective ECG Triggering Am. J. Roentgenol., March 1, 2009; 192(3): 635 - 638. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. R. Mayo and J. A. Leipsic Radiation Dose in Cardiac CT Am. J. Roentgenol., March 1, 2009; 192(3): 646 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. van Werkhoven, J. D. Schuijf, O. Gaemperli, J. W. Jukema, E. Boersma, W. Wijns, P. Stolzmann, H. Alkadhi, I. Valenta, M. P.M. Stokkel, et al. Prognostic value of multislice computed tomography and gated single-photon emission computed tomography in patients with suspected coronary artery disease. J. Am. Coll. Cardiol., February 17, 2009; 53(7): 623 - 632. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Hausleiter, T. Meyer, F. Hermann, M. Hadamitzky, M. Krebs, T. C. Gerber, C. McCollough, S. Martinoff, A. Kastrati, A. Schomig, et al. Estimated Radiation Dose Associated With Cardiac CT Angiography JAMA, February 4, 2009; 301(5): 500 - 507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Einstein Radiation Protection of Patients Undergoing Cardiac Computed Tomographic Angiography JAMA, February 4, 2009; 301(5): 545 - 547. [Full Text] [PDF]
|
|
|
|
|
|
G. M. Feuchtner, P. Stolzmann, W. Dichtl, T. Schertler, J. Bonatti, H. Scheffel, S. Mueller, A. Plass, L. Mueller, T. Bartel, et al. Multislice computed tomography in infective endocarditis comparison with transesophageal echocardiography and intraoperative findings. J. Am. Coll. Cardiol., February 3, 2009; 53(5): 436 - 444. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. F Tops and M. J Schalij Multislice CT: is it essential before atrial fibrillation ablation? Heart, August 1, 2008; 94(8): 973 - 975. [Full Text] [PDF]
|
|
|
|
|
|
W. P. Shuman, K. R. Branch, J. M. May, L. M. Mitsumori, D. W. Lockhart, T. J. Dubinsky, B. H. Warren, and J. H. Caldwell Prospective versus Retrospective ECG Gating for 64-Detector CT of the Coronary Arteries: Comparison of Image Quality and Patient Radiation Dose Radiology, August 1, 2008; 248(2): 431 - 437. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Hirai, J. Horiguchi, C. Fujioka, M. Kiguchi, H. Yamamoto, N. Matsuura, T. Kitagawa, H. Teragawa, N. Kohno, and K. Ito Prospective versus Retrospective ECG-gated 64-Detector Coronary CT Angiography: Assessment of Image Quality, Stenosis, and Radiation Dose Radiology, August 1, 2008; 248(2): 424 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Bluemke, S. Achenbach, M. Budoff, T. C. Gerber, B. Gersh, L. D. Hillis, W. G. Hundley, W. J. Manning, B. F. Printz, M. Stuber, et al. Noninvasive Coronary Artery Imaging: Magnetic Resonance Angiography and Multidetector Computed Tomography Angiography: A Scientific Statement From the American Heart Association Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention, and the Councils on Clinical Cardiology and Cardiovascular Disease in the Young Circulation, July 29, 2008; 118(5): 586 - 606. [Full Text] [PDF]
|
|
|
|
|
|
G. M. Feuchtner, W. Dichtl, S. Muller, D. Jodocy, T. Schachner, A. Klauser, and J. O. Bonatti 64-MDCT for Diagnosis of Aortic Regurgitation in Patients Referred to CT Coronary Angiography Am. J. Roentgenol., July 1, 2008; 191(1): W1 - W7. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W T Roberts, J J Bax, and L C Davies Cardiac CT and CT coronary angiography: technology and application Heart, June 1, 2008; 94(6): 781 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Boxt CT angiography in children: it is accurate, but is it safe? J. Am. Coll. Cardiol. Img., May 1, 2008; 1(3): 340 - 342. [Full Text] [PDF]
|
|
|
|
 |
|
 K. L. Gould, T. Pan, C. Loghin, N. P. Johnson, and S. Sdringola Reducing Radiation Dose in Rest-Stress Cardiac PET/CT by Single Poststress Cine CT for Attenuation Correction: Quantitative Validation J. Nucl. Med., May 1, 2008; 49(5): 738 - 745. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. M. Kramer All High-Risk Patients Should Not Be Screened With Computed Tomographic Angiography Circulation, March 11, 2008; 117(10): 1333 - 1339. [Full Text] [PDF]
|
|
|
|
|
|
S. Achenbach, U. Ropers, A. Kuettner, K. Anders, T. Pflederer, S. Komatsu, W. Bautz, W. G. Daniel, and D. Ropers Randomized comparison of 64-slice single- and dual-source computed tomography coronary angiography for the detection of coronary artery disease. J. Am. Coll. Cardiol. Img., March 1, 2008; 1(2): 177 - 186. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Earls, E. L. Berman, B. A. Urban, C. A. Curry, J. L. Lane, R. S. Jennings, C. C. McCulloch, J. Hsieh, and J. H. Londt Prospectively Gated Transverse Coronary CT Angiography versus Retrospectively Gated Helical Technique: Improved Image Quality and Reduced Radiation Dose Radiology, March 1, 2008; 246(3): 742 - 753. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Leschka, P. Koepfli, L. Husmann, A. Plass, R. Vachenauer, O. Gaemperli, T. Schepis, M. Genoni, B. Marincek, F. R. Eberli, et al. Myocardial Bridging: Depiction Rate and Morphology at CT Coronary Angiography--Comparison with Conventional Coronary Angiography Radiology, March 1, 2008; 246(3): 754 - 762. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Schroeder, S. Achenbach, F. Bengel, C. Burgstahler, F. Cademartiri, P. de Feyter, R. George, P. Kaufmann, A. F. Kopp, J. Knuuti, et al. Cardiac computed tomography: indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology Eur. Heart J., February 2, 2008; 29(4): 531 - 556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Horiguchi, M. Kiguchi, C. Fujioka, Y. Shen, R. Arie, K. Sunasaka, and K. Ito Radiation Dose, Image Quality, Stenosis Measurement, and CT Densitometry Using ECG-Triggered Coronary 64-MDCT Angiography: A Phantom Study Am. J. Roentgenol., February 1, 2008; 190(2): 315 - 320. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Pugliese, N. R. Mollet, M. G. M. Hunink, F. Cademartiri, K. Nieman, R. T. van Domburg, W. B. Meijboom, C. Van Mieghem, A. C. Weustink, M. L. Dijkshoorn, et al. Diagnostic Performance of Coronary CT Angiography by Using Different Generations of Multisection Scanners: Single-Center Experience Radiology, February 1, 2008; 246(2): 384 - 393. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Husmann, I. Valenta, O. Gaemperli, O. Adda, V. Treyer, C. A. Wyss, P. Veit-Haibach, F. Tatsugami, G. K. von Schulthess, and P. A. Kaufmann Feasibility of low-dose coronary CT angiography: first experience with prospective ECG-gating Eur. Heart J., January 2, 2008; 29(2): 191 - 197. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Schoenhagen Back to the future: coronary CT angiography using prospective ECG triggering Eur. Heart J., January 2, 2008; 29(2): 153 - 154. [Full Text] [PDF]
|
|
|
|
|
|
J. Hausleiter, T. Meyer, M. Hadamitzky, M. Zankl, P. Gerein, K. Dorrler, A. Kastrati, S. Martinoff, and A. Schomig Non-invasive coronary computed tomographic angiography for patients with suspected coronary artery disease: the Coronary Angiography by Computed Tomography with the Use of a Submillimeter resolution (CACTUS) trial Eur. Heart J., December 2, 2007; 28(24): 3034 - 3041. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Abdulla, S. Z. Abildstrom, O. Gotzsche, E. Christensen, L. Kober, and C. Torp-Pedersen 64-multislice detector computed tomography coronary angiography as potential alternative to conventional coronary angiography: a systematic review and meta-analysis Eur. Heart J., December 2, 2007; 28(24): 3042 - 3050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. M. Hurwitz, R. E. Reiman, T. T. Yoshizumi, P. C. Goodman, G. Toncheva, G. Nguyen, and C. Lowry Radiation Dose from Contemporary Cardiothoracic Multidetector CT Protocols with an Anthropomorphic Female Phantom: Implications for Cancer Induction Radiology, December 1, 2007; 245(3): 742 - 750. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hamon, R. Morello, J. W. Riddell, and M. Hamon Coronary Arteries: Diagnostic Performance of 16- versus 64-Section Spiral CT Compared with Invasive Coronary Angiography Meta-Analysis Radiology, December 1, 2007; 245(3): 720 - 731. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. B Meijboom, N. R Mollet, C. A Van Mieghem, A. C Weustink, F. Pugliese, N. van Pelt, F. Cademartiri, E. Vourvouri, P. de Jaegere, G. P Krestin, et al. 64-Slice CT coronary angiography in patients with non-ST elevation acute coronary syndrome Heart, November 1, 2007; 93(11): 1386 - 1392. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. B. Meijboom, C. A.G. van Mieghem, N. R. Mollet, F. Pugliese, A. C. Weustink, N. van Pelt, F. Cademartiri, K. Nieman, E. Boersma, P. de Jaegere, et al. 64-Slice Computed Tomography Coronary Angiography in Patients With High, Intermediate, or Low Pretest Probability of Significant Coronary Artery Disease J. Am. Coll. Cardiol., October 9, 2007; 50(15): 1469 - 1475. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Einstein, K. W. Moser, R. C. Thompson, M. D. Cerqueira, and M. J. Henzlova Radiation Dose to Patients From Cardiac Diagnostic Imaging Circulation, September 11, 2007; 116(11): 1290 - 1305. [Full Text] [PDF]
|
|
|
|
|
|
G. M. Feuchtner, T. Schachner, J. Bonatti, G. J. Friedrich, P. Soegner, A. Klauser, and D. z. Nedden Diagnostic Performance of 64-Slice Computed Tomography in Evaluation of Coronary Artery Bypass Grafts Am. J. Roentgenol., September 1, 2007; 189(3): 574 - 580. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Malagutti, K. Nieman, W. B. Meijboom, C. A.G. van Mieghem, F. Pugliese, F. Cademartiri, N. R. Mollet, E. Boersma, P. P. de Jaegere, and P. J. de Feyter Use of 64-slice CT in symptomatic patients after coronary bypass surgery: evaluation of grafts and coronary arteries Eur. Heart J., August 1, 2007; 28(15): 1879 - 1885. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Einstein, M. J. Henzlova, and S. Rajagopalan Estimating Risk of Cancer Associated With Radiation Exposure From 64-Slice Computed Tomography Coronary Angiography JAMA, July 18, 2007; 298(3): 317 - 323. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Ector, O. Dragusin, B. Adriaenssens, W. Huybrechts, R. Willems, H. Ector, and H. Heidbuchel Obesity Is a Major Determinant of Radiation Dose in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation J. Am. Coll. Cardiol., July 17, 2007; 50(3): 234 - 242. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. M. Feuchtner, S. Muller, J. Bonatti, T. Schachner, C. Velik-Salchner, O. Pachinger, and W. Dichtl Sixty-Four Slice CT Evaluation of Aortic Stenosis Using Planimetry of the Aortic Valve Area Am. J. Roentgenol., July 1, 2007; 189(1): 197 - 203. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Cademartiri, J. D. Schuijf, F. Pugliese, N. R. Mollet, J. W. Jukema, E. Maffei, L. J. Kroft, A. Palumbo, D. Ardissino, P. W. Serruys, et al. Usefulness of 64-Slice Multislice Computed Tomography Coronary Angiography to Assess In-Stent Restenosis J. Am. Coll. Cardiol., June 5, 2007; 49(22): 2204 - 2210. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kumar, K. G. Bis, A. Shetty, A. Vyas, A. Anderson, M. Balasubramaniam, W. O'Neill, and W. Stein Aortic Root Catheter-Directed Coronary CT Angiography in Swine: Coronary Enhancement with Minimum Volume of Iodinated Contrast Material Am. J. Roentgenol., May 1, 2007; 188(5): W415 - W422. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Leschka, E. Oechslin, L. Husmann, L. Desbiolles, B. Marincek, M. Genoni, R. Pretre, R. Jenni, S. Wildermuth, and H. Alkadhi Pre- and Postoperative Evaluation of Congenital Heart Disease in Children and Adults with 64-Section CT RadioGraphics, May 1, 2007; 27(3): 829 - 846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Ropers, F.-K. Pohle, A. Kuettner, T. Pflederer, K. Anders, W. G. Daniel, W. Bautz, U. Baum, and S. Achenbach Diagnostic Accuracy of Noninvasive Coronary Angiography in Patients After Bypass Surgery Using 64-Slice Spiral Computed Tomography With 330-ms Gantry Rotation Circulation, November 28, 2006; 114(22): 2334 - 2341. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Ghostine, C. Caussin, B. Daoud, M. Habis, E. Perrier, D. Pesenti-Rossi, A. Sigal-Cinqualbre, C.-Y. Angel, B. Lancelin, A. Capderou, et al. Non-Invasive Detection of Coronary Artery Disease in Patients With Left Bundle Branch Block Using 64-Slice Computed Tomography J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1929 - 1934. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Achenbach Computed Tomography Coronary Angiography J. Am. Coll. Cardiol., November 21, 2006; 48(10): 1919 - 1928. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Vogel-Claussen, H. Pannu, P. J. Spevak, E. K. Fishman, and D. A. Bluemke Cardiac Valve Assessment with MR Imaging and 64-Section Multi-Detector Row CT RadioGraphics, November 1, 2006; 26(6): 1769 - 1784. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. B. Meijboom, N. R. Mollet, C. A.G. Van Mieghem, J. Kluin, A. C. Weustink, F. Pugliese, E. Vourvouri, F. Cademartiri, A. J.J.C. Bogers, G. P. Krestin, et al. Pre-Operative Computed Tomography Coronary Angiography to Detect Significant Coronary Artery Disease in Patients Referred for Cardiac Valve Surgery J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1658 - 1665. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Garcia, J. Lessick, M. H. K. Hoffmann, and for the CATSCAN Study Investigators Accuracy of 16-row multidetector computed tomography for the assessment of coronary artery stenosis. JAMA, July 26, 2006; 296(4): 403 - 411. [Abstract] [Full Text] [PDF]
|
|