Evaluating radiation exposure of patients with stable chest pain in the SCOT-HEART trial

Justin Chiong, Prasad Guntur Ramkumar, Nicholas W Weir, Jonathan R Weir-McCall, Alberto Nania, Leslee J Shaw, Andrew J. Einstein, Marc R Dweck, Nicholas L Mills, David E Newby, Edwin J R van Beek, Giles Roditi, Michelle C Williams

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

In the Scottish COmputed Tomography of the Heart (SCOT-HEART) trial (NCT01149590) of individuals with stable chest pain, a management strategy based on coronary CTA led to improved patient outcomes.

To assess 5-year cumulative radiation doses of patients undergoing investigation for suspected angina due to coronary artery disease with or without coronary CTA

Materials and Methods
This secondary analysis of the SCOT-HEART trial included data from 6 of 12 recruiting and 2 of 3 imaging sites. Study participants had been randomized (1:1) to standard care plus CT (n = 1466) or standard care alone (n = 1428). Imaging was performed on a 64-detector (n=223) or 320-detector row scanner (n=1466). We assessed radiation dose from CT (dose-length product), single photon emission CT (SPECT, injected activity), and invasive coronary angiography (ICA, kerma-area product) over 5 years following enrollment. Effective dose was calculated using conversion factors appropriate for the imaging modality and body region imaged (using 0.026 mSv/mGy.cm for cardiac CT).

Cumulative radiation dose was assessed in 2,894 participants between November 2010 and September 2014. Median effective dose was 3.0 mSv (interquartile range [IQR], 2.6-3.3) for coronary calcium scoring, 4.1 mSv (IQR, 2.6-6.1) for coronary CTA, 7.4 mSv (IQR, 6.2-8.5) for SPECT, and 4.1 mSv (IQR, 2.5-6.8) for ICA. After 5 years, total per-participant cumulative dose was higher in the CT group (median, 8.1 mSv [IQR, 5.5-12.4 mSv]) compared to standard care group (median, 0 mSv [IQR, 0-4.5 mSv], P < .001). In participants who underwent any imaging, cumulative radiation exposure was higher in the CT (n=1345, median, 8.6 mSv [IQR, 6.1-13.3 mSv]) compared to standard care group (n=549, median, 6.4 mSv [IQR, 3.4-9.2 mSv], P< .001).

In the SCOT-HEART trial, the 5-year cumulative radiation dose from cardiac imaging was higher in the coronary CT angiography group compared to the standard of care group, largely due to the radiation exposure from CT.
Original languageEnglish
Publication statusPublished - 1 Aug 2023


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