Radiation dose of coronary CT angiography with a third-generation dual-source CT in a "real-world" patient population

To assess radiation dose and image quality of coronary computed tomography angiography (cCTA) with a third-generation dual-source scanner in a real-world patient population.

Scans of otherwise unselected, consecutive patients referred for clinically indicated cCTA between June 2015 and November 2017 were included for retrospective analysis. Scan protocol was based on heart rate: prospectively ECG-gated high-pitch spiral below 60 beats per minute (bpm), prospectively ECG-gated sequential scan between 61 and 70 bpm, and retrospective spiral above 70 bmp or at irregular heart rates. Objective image quality was measured as signal-to-noise (SNR) and contrast-to-noise ratio (CNR); subjective image quality was evaluated using a five-point Likert scale by two independent readers. For radiation dose analysis, effective dose, size-specific dose estimates, and volume CT dose index were assessed.

Two hundred seventy-eight patients (median age, 60 years; 155 men) with a median body mass index of 26.6 kg/m² (range, 16.7-60.9 kg/m²; 180 (64.7%) overweight or obese) were included (122 in the high-pitch spiral group, 60 in the prospective sequence group, and 96 in the retrospective spiral group). Median effective dose was 0.63 mSv (interquartile range [IQR], 0.51-0.90 mSv) for high-pitch spiral, 1.32 mSv (IQR, 0.79-2.46 mSv) for prospective sequence, and 4.77 (IQR, 3.02-8.27 mSv) for retrospective spiral (p < 0.001). Most studies had at least very good image quality (91.4/88.8% R1/R2), with highest SNR and CNR in the high-pitch spiral group.

cCTA with sufficient image quality is achievable at reasonably low radiation exposure in a real-world patient collective with a high proportion of overweight or obese patients.

• Submillisievert radiation dose coronary CT angiography with good diagnostic image quality is feasible in the majority of cases in a real-world patient using high-pitch spiral. • Prospective sequence results in about double median effective dose compared to the high-pitch protocol. • To optimize individual radiation exposure, lowering the heart rate is paramount, as it allows for choosing a dose-optimized (high-pitch spiral) scan protocol.