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In vivo reduction of radiation exposure
with a single-source coronary CT
angiography
effects of optimal parameters settings in
real life conditions
Alain Tavildari MD; François Vochelet MD; Luc Maillard MD PhD
Clinique AXIUM – Aix en Provence - FRANCE
FINANCIAL DISCLOSURES
 None
BACKGROUND
 Coronary computed tomographic
angiography (CCTA) has become a
common diagnostic test for evaluating
patients with coronary artery disease
 Radiation exposure has been deemed
too high
OBJECTIVES
 To assess the feasibility of in vivo radiation
reduction only by modifying acquisition
parameters in real life conditions with a
single source 64-slice CT
 Comparison of radiation exposure with
conventional angiography
METHOD
 Patients :
 Over 18 YO
 Co-morbidities including diabetes mellitus and
overweight were not excluded
 Coronary calcifications were not excluded
 All patients recieved sublingual nitrate
 Target heart rate was under 65 bpm at
acquisition time
 Atenolol intraveinously was given if needed
 Informed consent was obtained for all patients
METHOD
 Acquisition parameters :
 General Electric VCT Xte
 Prospective acquisition if heart rate (HR) under 65 bpm
 80 kV or 100 kV
 120 mA to 400 mA
 Acquisition at 75% of R-R intervall
 No padding
 Retrospective acquisition if HR between 65 and 75 bpm
 80 kV or 100 kV
 Modulation limited to 400 mA (maximum around
phase 75%)
 Reconstruction every 10% from phase 0% to phase 90%
METHOD
 Image quality :
 Evaluatued on a per-segment basis using the
American Heart Association coronary model
 Two independant observers gradded image quality
on a 4 point scale
 1 : excellent : vessel fully evaluable, no artifact
 2 : good : vessel fully evaluable, slight artifacts
 3 : fair : evaluable concerning the presence of
stenosis, blurred vessel margins
 4 : unevaluable
 Average quotation was taken into account if in case
of difference between the 2 observers
METHOD
 Radiation dose
 Based on the dose-lenght product (DLP,
mGy.cm), and effective dose (ED, mSv)
 ED derived from DLP using a conversion
factor of 0.014 for male and 0.017 for female
METHOD
 Conventional angiography
 Performed for patients with coronary stenosis on CT
 GE Innova® all-digital X-Ray system
 No ventriculography
 Radiation dose expressed with Dose Surface Product
 Conversion factor for ED = 0.2
IMAGE QUALITY = 1 (excellent)
IMAGE QUALITY = 2 (good)
IMAGE QUALITY = 3 (fair)
IMAGE QUALITY = 4 (unevaluable)
RESULTS : patients characteristics (n=137)
IMAGE QUALITY
 Over 2055 segments
 97.7 % were evaluable (quality score 1,2 or3)
 86 % were good or excellent (quality score 1 or 2)
RESULTS
 Prospective acquisition has been
performed for 85.4 % of patients (n=117)
 Conventional angiography done for 20
patients to confirm coronary stenosis
seen on CT
RESULTS
p < 0.0001
p < 0.0001
SUMMARY
 Our study was able to demonstrate that very low dose
coronary CT is feasible with a standard 64 slice CT
 Radiation dose was dramatically reduced in all
acquisition modes compared to historical data and to
conventional angiography
 Prefered mode is prospective
STUDY LIMITATION
 Non randomized study
 Single center
 Conventional angiography not made for all patients
 Subjective image quality evaluation
CONCLUSION
 These data may reconsider the decisional algorithm for
coronary artery stenosis detection
 Radiation dose for the whole studied population is nearly
as low as a mammogram
 CCTA could be proposed, with the parameter settings
used in this study, for screening asymptomatic patients
with high cardio-vascular risk factors

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Poster vienne ecr

  • 1. In vivo reduction of radiation exposure with a single-source coronary CT angiography effects of optimal parameters settings in real life conditions Alain Tavildari MD; François Vochelet MD; Luc Maillard MD PhD Clinique AXIUM – Aix en Provence - FRANCE
  • 3. BACKGROUND  Coronary computed tomographic angiography (CCTA) has become a common diagnostic test for evaluating patients with coronary artery disease  Radiation exposure has been deemed too high
  • 4. OBJECTIVES  To assess the feasibility of in vivo radiation reduction only by modifying acquisition parameters in real life conditions with a single source 64-slice CT  Comparison of radiation exposure with conventional angiography
  • 5. METHOD  Patients :  Over 18 YO  Co-morbidities including diabetes mellitus and overweight were not excluded  Coronary calcifications were not excluded  All patients recieved sublingual nitrate  Target heart rate was under 65 bpm at acquisition time  Atenolol intraveinously was given if needed  Informed consent was obtained for all patients
  • 6. METHOD  Acquisition parameters :  General Electric VCT Xte  Prospective acquisition if heart rate (HR) under 65 bpm  80 kV or 100 kV  120 mA to 400 mA  Acquisition at 75% of R-R intervall  No padding  Retrospective acquisition if HR between 65 and 75 bpm  80 kV or 100 kV  Modulation limited to 400 mA (maximum around phase 75%)  Reconstruction every 10% from phase 0% to phase 90%
  • 7. METHOD  Image quality :  Evaluatued on a per-segment basis using the American Heart Association coronary model  Two independant observers gradded image quality on a 4 point scale  1 : excellent : vessel fully evaluable, no artifact  2 : good : vessel fully evaluable, slight artifacts  3 : fair : evaluable concerning the presence of stenosis, blurred vessel margins  4 : unevaluable  Average quotation was taken into account if in case of difference between the 2 observers
  • 8. METHOD  Radiation dose  Based on the dose-lenght product (DLP, mGy.cm), and effective dose (ED, mSv)  ED derived from DLP using a conversion factor of 0.014 for male and 0.017 for female
  • 9. METHOD  Conventional angiography  Performed for patients with coronary stenosis on CT  GE Innova® all-digital X-Ray system  No ventriculography  Radiation dose expressed with Dose Surface Product  Conversion factor for ED = 0.2
  • 10. IMAGE QUALITY = 1 (excellent)
  • 11. IMAGE QUALITY = 2 (good)
  • 12. IMAGE QUALITY = 3 (fair)
  • 13. IMAGE QUALITY = 4 (unevaluable)
  • 14. RESULTS : patients characteristics (n=137)
  • 15. IMAGE QUALITY  Over 2055 segments  97.7 % were evaluable (quality score 1,2 or3)  86 % were good or excellent (quality score 1 or 2)
  • 16. RESULTS  Prospective acquisition has been performed for 85.4 % of patients (n=117)  Conventional angiography done for 20 patients to confirm coronary stenosis seen on CT
  • 18. SUMMARY  Our study was able to demonstrate that very low dose coronary CT is feasible with a standard 64 slice CT  Radiation dose was dramatically reduced in all acquisition modes compared to historical data and to conventional angiography  Prefered mode is prospective
  • 19. STUDY LIMITATION  Non randomized study  Single center  Conventional angiography not made for all patients  Subjective image quality evaluation
  • 20. CONCLUSION  These data may reconsider the decisional algorithm for coronary artery stenosis detection  Radiation dose for the whole studied population is nearly as low as a mammogram  CCTA could be proposed, with the parameter settings used in this study, for screening asymptomatic patients with high cardio-vascular risk factors