Evaluation of a Tube Voltage-Based Contrast Media Adaptation in Coronary Computed Tomography Angiography Using...

Area of Science:

• Radiology
• Cardiovascular Imaging
• Medical Physics

Background:

• Coronary CT angiography (CCTA) is a first-line diagnostic tool for suspected coronary artery disease (CAD).
• Increasing CCTA utilization necessitates strategies to minimize radiation and contrast medium (CM) exposure.
• Optimizing CM injection protocols is crucial for balancing diagnostic efficacy and patient safety.

Purpose of the Study:

• To evaluate an automated tube voltage selection (ATVS)-adapted CM injection protocol for CCTA.
• To compare its performance against a standard triphasic protocol regarding image quality, radiation dose, and CM administration.
• To assess the feasibility of reducing CM volume while maintaining diagnostic image quality.

Main Methods:

• Prospective enrollment of 120 patients undergoing CCTA with an ATVS-adapted triphasic CM protocol (70-130 kV).
• Comparison with 120 retrospective controls using a standard triphasic CM protocol on the same CT system.
• Evaluation of radiation dose, subjective image quality, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR).

Main Results:

• Significant reduction in CM volume in the ATVS group (46.0 mL) compared to the control group (51.3 mL) (p < 0.001).
• No significant differences in radiation dose (6.13 mSv vs. 5.97 mSv, p = 0.81).
• Comparable subjective image quality (median score 4 vs. 4, p = 0.40) and objective image quality (CNR, SNR) between groups.

Conclusions:

• The ATVS-adapted CM injection protocol enables diagnostic quality CCTA with reduced CM volume.
• This protocol maintains comparable radiation exposure and image quality to standard protocols.
• ATVS-adapted protocols represent a valuable advancement in optimizing CCTA procedures.