Radiation dose at cardiac computed tomography: facts and fiction

Cardiac computed tomography (CT) dosimetry makes use of two radiation parameters: a volume CT dose index (CTDI) and a dose length product (DLP). The volume CTDI quantifies the intensity of the radiation used to perform CT examinations, whereas DLP quantifies the amount of radiation used. CTDI metrics can be converted into patient dose metrics by using dose/CTDI conversion factors. In cardiac CT imaging, these need to take into account the x-ray tube voltage, scan length, and scan region, as well as patient size. Organ doses to patients in cardiac CT can be converted into cancer risks when patient demographic factors are taken into account. A risk analysis of patients undergoing cardiac CT angiography at our institution showed that a majority (62%) were males, with a median age of approximately 60 years and a median weight of approximately 90 kg. The median DLP was approximately 1100 mGy cm, corresponding to an effective dose of approximately 29 mSv in normal-sized patients. The average patient lifetime risk for a radiation-induced cancer was estimated to be 0.12%, with 85% of it attributed to lung cancer. Patients with an age and weight at the 10th percentile, who also received a DLP at the 90th percentile, would have cancer risk estimates approximately double the average value. Radiation risks are required to determine whether examinations are indicated, defined as examinations in which individual patient benefit exceeds corresponding patient risk. Understanding radiation risks in cardiac CT encourages operators to use the least amount of radiation to achieve satisfactory diagnostic performance.