Optimization of radiation dose reduction in cardiac computed tomographic angiography

Cardiology in Review

Volumn 19, Issue 4, 2011, Pages 163-176

  Entrikin, Daniel W ^a   Leipsic, Jonathon A ^b   Carr, J Jeffrey ^a  

^a WAKE FOREST SCHOOL OF MEDICINE   (United States)

^b UNIVERSITY OF BRITISH COLUMBIA   (Canada)

Author keywords

ALARA; cardiac computed tomographic angiography; medical radiation exposure; radiation dose reduction; radiation exposure

Indexed keywords

CLINICAL PROTOCOL; COMPUTED TOMOGRAPHIC ANGIOGRAPHY; DIAGNOSTIC IMAGING; HEART SCINTISCANNING; HUMAN; IMAGE QUALITY; PRACTICE GUIDELINE; PROCESS OPTIMIZATION; RADIATION DOSE; RADIATION EXPOSURE; REVIEW; RISK ASSESSMENT; STANDARDIZATION;

ALGORITHMS; CORONARY ANGIOGRAPHY; CORONARY ARTERY DISEASE; DOSE-RESPONSE RELATIONSHIP, RADIATION; ELECTROCARDIOGRAPHY; HUMANS; RISK ASSESSMENT; STATISTICS AS TOPIC; TOMOGRAPHY, X-RAY COMPUTED;

EID: 79959264397     PISSN: 10615377     EISSN: 15384683     Source Type: Journal    
DOI: 10.1097/CRD.0b013e31821daa8f     Document Type: Review

References (103)

1. Taylor AJ, Cerqueira M, Hodgson JM, et al. ACCF/SCCT/ACR/AHA/ASE/ASNC/ NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. J Cardiovasc Comput Tomogr. 2010;4:407.e1-e33.
2. Mettler FA, Bhargavan M, Faulkner K, et al. Radiologic and nuclear medicine studies in the United States and worldwide: frequency, radiation dose, and comparison with other radiation sources - 1950-20071. Radiology. 2009;253:520-531.
3. Mettler FA Jr, Thomadsen BR, Bhargavan M, et al. Medical radiation exposure in the U.S. in 2006: preliminary results. Health Phys. 2008;95:502-507.
4. Amis ES Jr, Butler PF, Applegate KE, et al. American College of Radiology white paper on radiation dose in medicine. J Am Coll Radiol. 2007;4:272-284. (Pubitemid 46671375)
5. Hounsfield GN. Computerized transverse axial scanning (tomography). Part 1: description of system. Br J Radiol. 1973;46:1016-1022.
6. Ambrose J. Computerized transverse axial scanning (tomography). Part 2: clinical application. Br J Radiol. 1973;46:1023-1047.
7. Perry BJ, Bridges C. Computerized transverse axial scanning (tomography). Part 3: radiation dose considerations. Br J Radiol. 1973;46:1048-1051.
8. Hounsfield GN. Computed medical imaging. Science. 1980;210:22-28. (Pubitemid 11192047)
9. Lackner K, Thurn P. Computed tomography of the heart: ECG-gated and continuous scans. Radiology. 1981;140:413-420. (Pubitemid 11039971)
10. Guthaner D, Wexler L, Harell G. CT demonstration of cardiac structures. Am J Roentgenol. 1979;133:75-81. (Pubitemid 9195719)
11. Adams D, Hessel S, Judy P, et al. Computed tomography of the normal and infarcted myocardium. Am J Roentgenol. 1976;126:786-791.
12. Higgins C, Siemers P, Schmidt W, et al. Evaluation of myocardial ischemic damage of various ages by computerized transmission tomography. Time-dependent effects of contrast material. Circulation. 1979;60:284-291. (Pubitemid 9229216)
13. Godwin JD, Herfkens RJ, Skiöldebrand CG, et al. Detection of intraventricular thrombi by computed tomography. Radiology. 1981;138:717-721. (Pubitemid 12192253)
14. Brundage B, Lipton M, Herfkens R, et al. Detection of patent coronary bypass grafts by computed tomography. A preliminary report. Circulation. 1980;61:826-831.
15. Guthaner D, Brody W, Ricci M, et al. The use of computed tomography in the diagnosis of coronary artery bypass graft patency. Cardiovasc Intervent Radiol. 1980;3:3-8. (Pubitemid 10157262)
16. Harell GS, Guthaner DF, Breiman RS, et al. Stop-action cardiac computed tomography. Radiology. 1977;123:515-517.
17. Ritman E, Kinsey J, Robb R, et al. Physics and technical considerations in the design of the DSR: a high temporal resolution volume scanner. Am J Roentgenol. 1980;134:369-374. (Pubitemid 10182157)
18. Lipton MJ, Higgins CB, Farmer D, et al. Cardiac imaging with a high-speed Cine-CT Scanner: preliminary results. Radiology. 1984;152:579-582. (Pubitemid 14060597)
19. Crawford CR, King KF. Computed tomography scanning with simultaneous patient translation. Med Phys. 1990;17:967-982.
20. Kalender WA, Seissler W, Klotz E, et al. Spiral volumetric CT with single-breath-hold technique, continuous transport, and continuous scanner rotation. Radiology. 1990;176:181-183. (Pubitemid 20208133)
21. Liang Y, Kruger RA. Dual-slice spiral versus single-slice spiral scanning: comparison of the physical performance of two computed tomography scanners. Med Phys. 1996;23:205-220. (Pubitemid 26060371)
22. Achenbach S, Ulzheimer S, Baum U, et al. Noninvasive coronary angiography by retrospectively ECG-gated multislice spiral CT. Circulation. 2000;102:2823-2828.
23. Einstein AJ, Henzlova MJ, Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007;298:317-323. (Pubitemid 47080486)
24. Fazel R, Krumholz HM, Wang Y, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361:849-857.
25. Schauer DA, Linton OW. National Council on Radiation Protection and Measurements Report shows substantial medical exposure increase. Radiology. 2009;253:293-296.
26. Gerber TC, Gibbons RJ. Weighing the risks and benefits of cardiac imaging with ionizing radiation. JACC Cardiovasc Imaging. 2010;3:528-535.
27. Laskey WK, Feinendegen LE, Neumann RD, et al. Low-level ionizing radiation from noninvasive cardiac imaging: can we extrapolate estimated risks from epidemiologic data to the clinical setting? JACC Cardiovasc Imaging. 2010;3:517-524.
28. Hausleiter J, Meyer T, Hermann F, et al. Estimated radiation dose associated with cardiac CT angiography. JAMA. 2009;301:500-507.
29. Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med. 2007;357:2277-2284. (Pubitemid 350190758)
30. Neumann RD, Bluemke DA. Tracking radiation exposure from diagnostic imaging devices at the NIH. J Am Coll Radiol. 2010;7:87-89.
31. Martin CJ. Effective dose: how should it be applied to medical exposures? Br J Radiol. 2007;80:639-647. (Pubitemid 47517809)
32. Martin CJ. The application of effective dose to medical exposures. Radiat Prot Dosimetry. 2008;128:1-4. (Pubitemid 351827514)
33. McCollough CH, Christner JA, Kofler JM. How effective is effective dose as a predictor of radiation risk? Am J Roentgenol. 2010;194:890-896.
34. Tubiana M, Feinendegen LE, Yang C, et al. The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology. 2009;251:13-22.
35. Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects Research, Division on Earth and Life Studies, National Research Counsil of the National Academies. Health Risks From Exposure to Low Levels of Ionizing Radiation: BIER VII-Phase 2. Washington, DC: National Academies Press; 2006.
36. IRCP. The 2007 Recommendations of the International Commission on Radiological Protection. ICRP Publication 103. Ann ICRP. 2007:37:1-332.
37. Jakobs T, Becker C, Ohnesorge B, et al. Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation. Eur Radiol. 2002;12:1081-1086. (Pubitemid 36940173)
38. Takakuwa KM, Halpern EJ, Gingold EL, et al. 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. 2009;192:866-872.
39. Herzog C, Mulvihill DM, Nguyen SA, et al. Pediatric cardiovascular CT angiography: radiation dose reduction using automatic anatomic tube current modulation. Am J Roentgenol. 2008;190:1232-1240. (Pubitemid 351684935)
40. Abada HT, Larchez C, Daoud B, et al. MDCT of the coronary arteries: feasibility of low-dose CT with ECG-pulsed tube current modulation to reduce radiation dose. Am J Roentgenol. 2006;186:S387-S390. (Pubitemid 46105409)
41. Earls JP, Leipsic J. Cardiac computed tomography technology and dose-reduction strategies. Radiol Clin North Am. 2010;48:657-674.
42. Hausleiter J, Meyer T, Hadamitzky M, et al. Radiation dose estimates from cardiac multislice computed tomography in daily practice: impact of different scanning protocols on effective dose estimates. Circulation. 2006;113:1305-1310. (Pubitemid 43739452)
43. Halliburton SS. Options for reducing patient radiation dose with cardiovascular computed tomography. Int J Cardiovasc Imaging. 2009;25:153-164.
44. Brooks RA. A quantitative theory of the Hounsfield unit and its application to dual energy scanning. J Comput Assist Tomogr. 1977;1:487-493. (Pubitemid 8228115)
45. Leschka S, Stolzmann P, Schmid F, et al. Low kilovoltage cardiac dualsource CT: attenuation, noise, and radiation dose. Eur Radiol. 2008;18:1809-1817.
46. Feuchtner GM, Jodocy D, Klauser A, et al. Radiation dose reduction by using 100-kV tube voltage in cardiac 64-slice computed tomography: a comparative study. Eur J Radiol. 2010;75:e51-e56.
47. Bischoff B, Hein F, Meyer T, et al. Impact of a reduced tube voltage on CT angiography and radiation dose results of the PROTECTION I study. JACC Cardiovasc Imaging. 2009;2:940-946.
48. Bischoff B, Hein F, Meyer T, et al. Trends in radiation protection in CT: present and future status. J Cardiovasc Comput Tomogr. 2009;3:S65-S73.
49. Hausleiter J, Martinoff S, Hadamitzky M, et al. Image quality and radiation exposure with a low tube voltage protocol for coronary CT angiography results of the PROTECTION II trial. JACC Cardiovasc Imaging. 2010;3:1113-1123.
50. La Bounty T, Leipsic J, Min J, et al. Multicenter, multivendor randomized trial of 80 vs 100 kVp CCTA in normal sized patients. 5th Annual Scientific Sessions of the Society of Cardiovascular Computed Tomography. July 15-18, 2010.
51. Earls JP, Berman EL, Urban BA, et al. Prospectively gated transverse coronary CT angiography versus retrospectively gated helical technique: improved image quality and reduced radiation dose 1. Radiology. 2008;246:742-753.
52. Hirai N, Horiguchi J, Fujioka C, et al. Prospective versus retrospective ECG-gated 64-detector coronary CT angiography: assessment of image quality, stenosis, and radiation dose. Radiology. 2008;248:424-430.
53. Maruyama T, Takada M, Hasuike T, et al. Radiation dose reduction and coronary assessability of prospective electrocardiogram-gated computed tomography coronary angiography: comparison with retrospective electrocardiogram-gated helical scan. J Am Coll Cardiol. 2008;52:1450-1455.
54. Arnoldi E, Johnson T, Rist C, et al. Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques. Eur Radiol. 2009;19:2147-2155.
55. Blankstein R, Shah A, Pale R, et al. Radiation dose and image quality of prospective triggering with dual-source cardiac computed tomography. Am J Cardiol. 2009;103:1168-1173.
56. Einstein AJ, Wolff SD, Manheimer ED, et al. Comparison of image quality and radiation dose of coronary computed tomographic angiography between conventional helical scanning and a strategy incorporating sequential scanning. Am J Cardiol. 2009;104:1343-1350.
57. Hoe J, Toh KH. First experience with 320-row multidetector CT coronary angiography scanning with prospective electrocardiogram gating to reduce radiation dose. J Cardiovasc Comput Tomogr. 2009;3:257-261.
58. Bischoff B, Hein F, Meyer T, et al. Comparison of sequential and helical scanning for radiation dose and image quality: results of the prospective multicenter study on radiation dose estimates of cardiac CT angiography (PROTECTION) I study. Am J Roentgenol. 2010;194:1495-1499.
59. Jin K, Park E-A, Shin C-I, et al. Retrospective versus prospective ECG-gated dual-source CT in pediatric patients with congenital heart diseases: comparison of image quality and radiation dose. Int J Cardiovasc Imaging. 2010;26:63-73.
60. Lehmkuhl L, Gosch D, Nagel HD, et al. Quantification of radiation dose savings in cardiac computed tomography using prospectively triggered mode and ECG pulsing: a phantom study. Eur Radiol. 2010;20:2116-2125.
61. LaBounty TM, Leipsic J, Min JK, et al. Effect of padding duration on radiation dose and image interpretation in prospectively ECG-triggered coronary CT angiography. Am J Roentgenol. 2010;194:933-937.
62. Earls JP, Schrack EC. Prospectively gated low-dose CCTA: 24 months experience in more than 2,000 clinical cases. Int J Cardiovasc Imaging. 2008;25:177-187.
63. Scheffel H, Alkadhi H, Leschka S, et al. Low-dose CT coronary angiography in the step-and-shoot mode: diagnostic performance. Heart. 2008;94:1132-1137.
64. Stolzmann P, Scheffel H, Leschka S, et al. Influence of calcifications on diagnostic accuracy of coronary CT angiography using prospective ECG triggering. Am J Roentgenol. 2008;191:1684-1689.
65. Dewey M, Zimmermann E, Deissenrieder F, et al. Noninvasive coronary angiography by 320-row computed tomography with lower radiation exposure and maintained diagnostic accuracy: comparison of results with cardiac catheterization in a head-to-head pilot investigation. Circulation. 2009;120:867-875.
66. Achenbach S, Marwan M, Schepis T, et al. High-pitch spiral acquisition: a new scan mode for coronary CT angiography. J Cardiovasc Comput Tomogr. 2009;3:117-121.
67. Hausleiter J, Bischoff B, Hein F, et al. Feasibility of dual-source cardiac CT angiography with high-pitch scan protocols. J Cardiovasc Comput Tomogr. 2009;3:236-242.
68. Lell M, Marwan M, Schepis T, et al. Prospectively ECG-triggered highpitch spiral acquisition for coronary CT angiography using dual source CT: technique and initial experience. Eur Radiol. 2009;19:2576-2583.
69. Sommer WH, Albrecht E, Bamberg F, et al. Feasibility and radiation dose of high-pitch acquisition protocols in patients undergoing dual-source cardiac CT. Am J Roentgenol. 2010;195:1306-1312.
70. Achenbach S, Marwan M, Ropers D, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Euro Heart J. 2010;31:340-346.
71. Lell M, Hinkmann F, Anders K, et al. High-pitch electrocardiogram- triggered computed tomography of the chest: initial results. Invest Radiol. 2009;44:728-733.
72. Petersilka M, Bruder H, Krauss B, et al. Technical principles of dual source CT. Eur J Radiol. 2008;68:362-368.
73. Thibault J-B, Sauer KD, Bouman CA, et al. A three-dimensional statistical approach to improved image quality for multislice helical CT. Med Phys. 2007;34:4526-4544. (Pubitemid 350029675)
74. Leipsic J, LaBounty TM, Heilbron B, et al. Estimated radiation dose reduction using adaptive statistical iterative reconstruction in coronary CT angiography: the ERASIR study. Am J Roentgenol. 2010;195:655-660.
75. Flohr TG, Schaller S, Stierstorfer K, et al. Multidetector row CT systems and image-reconstruction techniques. Radiology. 2005;235:756-773. (Pubitemid 40695869)
76. Walker MJ, Olszewski ME, Desai MY, et al. New radiation dose saving technologies for 256-slice cardiac computed tomography angiography. Int J Cardiovasc Imaging. 2009;25:189-199.
77. Gopal A, Budoff MJ. A new method to reduce radiation exposure during multi-row detector cardiac computed tomographic angiography. Int J Cardiol. 2009;132:435-436.
78. Christner JA, Zavaletta VA, Eusemann CD, et al. Dose reduction in helical CT: dynamically adjustable z-axis x-ray beam collimation. Am J Roentgenol. 2009;194:W49-W55.
79. Tzedakis A, Damilakis J, Perisinakis K, et al. The effect of z overscanning on patient effective dose from multidetector helical computed tomography examinations. Med Phys. 2005;32:1621-1629. (Pubitemid 40880556)
80. van der Molen AJ, Geleijns J. Overranging in multisection ct: quantification and relative contribution to dose - comparison of four 16-section CT scanners. Radiology. 2007;242:208-216. (Pubitemid 44956026)
81. Oncel D, Oncel G, Tastan A. Effectiveness of dual-source CT coronary angiography for the evaluation of coronary artery disease in patients with atrial fibrillation: initial experience. Radiology. 2007;245:703-711. (Pubitemid 350127340)
82. Budoff MJ. Maximizing dose reductions with cardiac CT. Int J Cardiovasc Imaging. 2008;25:279-287.
83. Budoff MJ. Ethical issues related to lung nodules on cardiac CT. Am J Roentgenol. 2009;192:W146.
84. Geleijns J, Wang J, McCollough C. The use of breast shielding for dose reduction in pediatric CT: arguments against the proposition. Pediatr Radiol. 2010;40:1744-1747.
85. Yilmaz MH, Albayram S, Yasar D, et al. Female breast radiation exposure during thorax multidetector computed tomography and the effectiveness of bismuth breast shield to reduce breast radiation dose. J Comput Assisted Tomogr. 2007;31:138-142. (Pubitemid 46183352)
86. Yilmaz MH, Yasar D, Albayram S, et al. Coronary calcium scoring with MDCT: the radiation dose to the breast and the effectiveness of bismuth breast shield. Eur J Radiol. 2007;61:139-143. (Pubitemid 46038015)
87. Kalra MK, Dang P, Singh S, et al. In-plane shielding for CT: effect of off-centering, automatic exposure control and shield-to-surface distance. Korean J Radiol. 2009;10:156-163.
88. Geleijns J, Salvadó Artells M, Veldkamp WJ, et al. Quantitative assessment of selective in-plane shielding of tissues in computed tomography through evaluation of absorbed dose and image quality. Eur Radiol. 2006;16:2334-2340. (Pubitemid 44349882)
89. Vollmar S, Kalender W. Reduction of dose to the female breast in thoracic CT: a comparison of standard-protocol, bismuth-shielded, partial and tube-current-modulated CT examinations. Eur Radiol. 2008;18:1674-1682.
90. Berland LL, Yester MV, Fitzpatrick AF. Reducing mAs is as effective as a bismuth breast shield to minimize breast dose for chest CT when keeping mediastinal noise constant. In: Proceedings of RSNA; 2009. Abstract (SSA04-05).
91. Coursey C, Frush DP, Yoshizumi T, et al. Pediatric chest mdct using tube current modulation: effect on radiation dose with breast shielding. Am J Roentgenol. 2008;190:W54-W61.
92. Shemesh J, Evron R, Koren-Morag N, et al. Coronary artery calcium measurement with multi-detector row CT and low radiation dose: comparison between 55 and 165 mAs1. Radiology. 2005;236:810-814. (Pubitemid 41170841)
93. Takahashi N, Bae KT. Quantification of coronary artery calcium with multi-detector row CT: assessing interscan variability with different tube currents - pilot study 1. Radiology. 2003;228:101-106. (Pubitemid 36736075)
94. Thomas CK, Muhlenbruch G, Wildberger JE, et al. Coronary artery calcium scoring with multislice computed tomography: in vitro assessment of a low tube voltage protocol. Invest Radiol. 2006;41:668-673. (Pubitemid 44213744)
95. Nakazato R, Dey D, Gutstein A, et al. Coronary artery calcium scoring using a reduced tube voltage and radiation dose protocol with dual-source computed tomography. J Cardiovasc Comput Tomogr. 2009;3:394-400.
96. Carr JJ, Nelson JC, Wong ND, et al. Calcified coronary artery plaque measurement with cardiac CT in population-based studies: standardized protocol of Multi-Ethnic Study of Atherosclerosis (MESA) and Coronary Artery Risk Development in Young Adults (CARDIA) study. Radiology. 2005;234:35-43. (Pubitemid 39658367)
97. Halliburton SS, Schoenhagen P. Cardiovascular imaging with computed tomography: responsible steps to balancing diagnostic yield and radiation exposure. JACC Cardiovasc Imaging. 2010;3:536-540.
98. Halpern EJ. Triple-rule-out ct angiography for evaluation of acute chest pain and possible acute coronary syndrome. Radiology. 2009;252:332-345.
99. Rogers IS, Banerji D, Siegel EL, et al. Usefulness of Comprehensive Cardiothoracic Computed Tomography in the Evaluation of Acute Undifferentiated Chest Discomfort in the Emergency Department (CAPTURE). Am J Cardiol. 2011;107:643-650.
100. Durmus T, Rogalla P, Lembcke A, et al. Low-dose triple-rule-out using 320-row-detector volume MDCT - less contrast medium and lower radiation exposure. Eur Radiol. In press.
101. Manheimer ED, Peters MR, Wolff SD, et al. Comparison of radiation dose and image quality of triple-rule-out computed tomography angiography between conventional helical scanning and a strategy incorporating sequential scanning. Am J Cardiol. 2011;107:1093-1098.
102. LaBounty TM, Earls JP, Leipsic J, et al. Effect of a standardized qualityimprovement protocol on radiation dose in coronary computed tomographic angiography. Am J Cardiol. 2010;106:1663-1667.
103. LaBounty TM, Leipsic J, Mancini GB, et al. Effect of a standardized radiation dose reduction protocol on diagnostic accuracy of coronary computed tomographic angiography. Am J Cardiol. 2010;106:287-292.