Reduction in Radiation Exposure in Cardiovascular CT Imaging

PROTECTION VI Investigators, T. Stocker, S. D. C. Deseive, J. Leipsic, M. Hadamitzky, M Chen, Ronen Rubinshtein, Mathias Heckner, Jeroen J Bax, Xiangming Fang, Erik Lerkevang Grove, J. Lesser, Pál Maurovich-Horvat, H. J. Otton, Sanghoon Shin, Gianluca Pontone, H. Marques, Benjamin Chow, Cesar H Nomura, Ramzi TabbalatAxel Schmermund, Joon-Wan Kang, Christopher Naoum, M ATKINSON, E. Martuscelli, Steffen Massberg, J. Hausleiter, Edwin van Beek (Member of Consortium)

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Aims Advances of cardiac computed tomography angiography (CTA) have been developed for dose reduction, but their efficacy in clinical practice is largely unknown. This study was designed to evaluate radiation dose exposure and utilization of dose-saving strategies for contrast-enhanced cardiac CTA in daily practice. Methods and results Sixty one hospitals from 32 countries prospectively enrolled 4502 patients undergoing cardiac CTA during one calendar month in 2017. Computed tomography angiography scan data and images were analysed in a central core lab and compared with a similar dose survey performed in 2007. Linear regression analysis was performed to identify independent predictors associated with dose. The most frequent indication for cardiac CTA was the evaluation of coronary artery disease in 89% of patients. The median dose-length product (DLP) of coronary CTA was 195 mGy*cm (interquartile range 110–338 mGy*cm). When compared with 2007, the DLP was reduced by 78% (P < 0.001) without an increase in non-diagnostic coronary CTAs (1.7% in 2007 vs. 1.9% in 2017 surveys, P = 0.55). A 37-fold variability in median DLP was observed between the hospitals with lowest and highest DLP (range of median DLP 57–2090 mGy*cm). Independent predictors for radiation dose of coronary CTA were: body weight, heart rate, sinus rhythm, tube voltage, iterative image reconstruction, and the selection of scan protocols. Conclusion This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.
Original languageEnglish
JournalEuropean Heart Journal
Early online date25 Aug 2018
Publication statusPublished - Nov 2018


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