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Radiation dose reduction of 50% in dynamic myocardial CT perfusion with skipped beat acquisition: a retrospective
Olga Sliwicka1,2, Luuk J Oostveen1,2, Zaneta Swiderska Chadaj3
1Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
Insights
Skipping heartbeats during dynamic myocardial computed tomography perfusion (CTP) significantly reduces radiation dose by up to 50% without compromising diagnostic performance. This method is feasible for cardiac imaging.
Area of Science:
- Cardiovascular imaging
- Radiology
- Medical physics
Background:
- Dynamic myocardial computed tomography perfusion (CTP) is a valuable cardiac imaging technique.
- Current CTP protocols involve substantial radiation exposure.
- Reducing radiation dose is crucial for patient safety and increasing CT applicability.
Purpose of the Study:
- To assess the feasibility of dose reduction in dynamic CTP.
- To compare image quality and diagnostic performance between all-heartbeat and skipped-heartbeat acquisitions.
- To determine optimal heartbeat skipping strategies for radiation dose reduction.
Main Methods:
- Retrieved dynamic CTP data from 38 patients.
- Created datasets by removing every fourth, third, or second heartbeat (Skip1:4, Skip1:3, Skip1:2).
- Seven observers evaluated images and perfusion maps for deficits; quantitative analysis of mean blood flow (MBF) was performed.
Main Results:
- Skip1:2 protocol showed minimal additional false-negative segments (0.8%) and cases (2).
- Quantitative MBF analysis demonstrated comparable results across all protocols, with normalized MBF values close to 1.
- Variability in MBF analysis for the reference condition resulted in 1.3% additional false-negative segments.
Conclusions:
- Skipping every second heartbeat in dynamic CTP is feasible, potentially reducing radiation dose by 50%.
- Diagnostic performance is maintained even with a 50% reduction in acquired time points.
- This approach offers a promising strategy for safer cardiac CT imaging.
Background:
Dynamic myocardial computed tomography perfusion (CTP) is a novel imaging technique that increases the applicability of CT for cardiac imaging; however, the scanning requires a substantial radiation dose.
Purpose:
To investigate the feasibility of dose reduction in dynamic CTP by comparing all-heartbeat acquisitions to periodic skipping of heartbeats.
Material And Methods:
We retrieved imaging data of 38 dynamic CTP patients and created new datasets with every fourth, third or second beat (Skip1:4, Skip1:3, Skip1:2, respectively) removed. Seven observers evaluated the resulting images and perfusion maps for perfusion deficits. The mean blood flow (MBF) in each of the 16 myocardial segments was compared per skipped-beat level, normalized by the respective MBF for the full dose, and averaged across patients. The number of segments/cases whose MBF was <1.0 mL/g/min were counted.
Results:
Out of 608 segments in 38 cases, the total additional number of false-negative (FN) segments over those present in the full-dose acquisitions and the number of additional false-positive cases were shown as acquisition (segment [%], case): Skip1:4: 7 (1.2%, 1); Skip1:3: 12 (2%, 3), and Skip1:2: 5 (0.8%, 2). The variability in quantitative MBF analysis in the repeated analysis for the reference condition resulted in 8 (1.3%) additional FN segments. The normalized results show a comparable MBF across all segments and patients, with relative mean MBFs as 1.02 ± 0.16, 1.03 ± 0.25, and 1.06 ± 0.30 for the Skip1:4, Skip1:3, and Skip1:2 protocols, respectively.
Conclusion:
Skipping every second beat acquisition during dynamic myocardial CTP appears feasible and may result in a radiation dose reduction of 50%. Diagnostic performance does not decrease after removing 50% of time points in dynamic sequence.
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