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Evaluating Radiation Exposure in Patients with Stable Chest Pain in the SCOT-HEART Trial

Justin Chiong1, Prasad Guntur Ramkumar1, Nicholas W Weir1

  • 1From the British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.); Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK (G.R.).

Radiology
|August 1, 2023
PubMed

Insights

The SCOT-HEART trial found that patients receiving coronary CT angiography (CTA) had higher 5-year cumulative radiation doses compared to standard care. This increased exposure was primarily due to CT imaging, highlighting radiation dose considerations in cardiac diagnostics.

Area of Science:

  • Radiology
  • Cardiology
  • Medical Imaging

Background:

  • The Scottish Computed Tomography of the Heart (SCOT-HEART) trial demonstrated improved outcomes with coronary CT angiography (CTA) in stable chest pain patients.
  • This study focuses on the radiation dose implications of CTA within the SCOT-HEART trial framework.

Purpose of the Study:

  • To assess the 5-year cumulative radiation doses in patients investigated for suspected angina.
  • To compare radiation exposure between standard care with CT and standard care alone groups.

Main Methods:

  • Secondary analysis of the SCOT-HEART trial data from selected sites.
  • Radiation dose assessment included CT, SPECT, and invasive coronary angiography (ICA) over 5 years.
  • Effective dose calculated using modality-specific conversion factors.

Main Results:

  • Median cumulative radiation doses varied by modality: coronary calcium scoring (3.0 mSv), coronary CTA (4.1 mSv), SPECT (7.4 mSv), and ICA (4.1 mSv).
  • The CT group had a significantly higher 5-year cumulative radiation dose (median 8.1 mSv) than the standard-care group (median 0 mSv; P < .001).
  • Participants undergoing any imaging in the CT group had higher cumulative exposure (median 8.6 mSv) versus standard care (median 6.4 mSv; P < .001).

Conclusions:

  • The 5-year cumulative radiation dose from cardiac imaging was significantly higher in the coronary CT angiography group compared to the standard-care group.
  • The increased radiation exposure in the CT group was predominantly attributed to CT imaging procedures.

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