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Computed tomography to diagnose coronary artery disease: a reduction in radiation dose increases applicability
O Gosling1, G Morgan-Hughes, S Iyengar
1Institute of Biomedical & Clinical Science, Peninsula College of Medicine & Dentistry, NIHR Clinical Research Facility, University of Exeter, Exeter, UK. Oliver.gosling@pms.ac.uk
Insights
Implementing dose-saving algorithms significantly reduced radiation exposure in computed tomography coronary angiography (CTCA). These advancements in CTCA technology ensure patient safety by minimizing radiation dose while maintaining diagnostic accuracy.
Area of Science:
- Radiology
- Medical Imaging
- Cardiovascular Imaging
Background:
- Computed Tomography Coronary Angiography (CTCA) is a vital diagnostic tool.
- Radiation dose is a critical consideration in CTCA procedures.
- Optimizing dose-saving strategies is essential for patient safety.
Purpose of the Study:
- To evaluate the impact of dose-saving algorithms on radiation dose in CTCA.
- To assess the effectiveness of technological advancements in reducing radiation exposure.
- To establish benchmarks for radiation dose in clinical CTCA services.
Main Methods:
- Retrospective analysis of 1736 CTCA examinations over 3 years.
- Calculation of effective radiation dose using a cardiac-specific conversion factor.
- Stratification of patients based on the implementation of new scanning technology and dose-saving protocols.
Main Results:
- Initial mean effective dose was 29.6 mSv.
- Implementation of prospective ECG gating reduced dose to 13.6 mSv.
- Further optimization with 100 kV and minimal exposure time reduced dose to 5.9 mSv.
Conclusions:
- Evidence-based protocols and dose-saving algorithms significantly decrease effective radiation dose in CTCA.
- Continuous adoption of dose-saving technologies is recommended for CTCA services.
- Minimizing radiation exposure, as low as reasonably practical, is crucial for ongoing CTCA development.
Aim:
To assess the effects of dose-saving algorithms on the radiation dose in an established computed tomography coronary angiography (CTCA) clinical service.
Materials And Methods:
A 3 year retrospective analysis of all patients attending for a clinically indicated CTCA was performed. The effective dose was calculated using a cardiac-specific conversion factor [0.028 mSv(mGy·cm)(-1)]. Patients were stratified by the advent of new scanning technology and dose-saving protocols.
Results:
Between September 2007 and August 2010, 1736 examinations were performed. In the first 6 months, 150 examinations were performed with a mean effective dose of 29.6 mSv (99% CI 26.6-33 mSv). In March 2008 prospective electrocardiogram (ECG) gating was installed; reducing the effective dose to 13.6 mSv (99% CI 12.5-14.9 mSv). In March 2009, the scanner parameters were set to a minimal exposure time and 100 kV in patients with a body mass index (BMI) of <30. This reduced the mean dose to 7.4 mSv (99% CI 6.8-8 mSv). For the final six months the mean radiation dose for a cardiac scan was 5.9 mSv (99% CI 5.4-6.5 mSv) this figure incorporates all examinations performed irrespective of the protocol used.
Conclusion:
With the implementation of evidence-based protocols, the effective dose from cardiac CT has significantly reduced. As CTCA services develop dose-saving algorithms should be adopted to keep the radiation dose as low as reasonably practical.
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