Open AccessJournal Article
Estimated Radiation Dose Associated With Cardiac CT Angiography. Commentary
Jörg Hausleiter,Tanja Meyer,Franziska Hermann,Martin Hadamitzky,Markus Krebs,Thomas C. Gerber,Cynthia H. McCollough,Stefan Martinoff,Adnan Kastrati,Albert Schömig,Stephan Achenbach,Andrew J. Einstein +11 more
Reads0
Chats0
TLDR
The comparable diagnostic image quality of CCTA may support an increased use of dose-saving strategies in adequately selected patients and effective strategies to reduce radiation dose are available but some strategies are not frequently used.Abstract:
Context Cardiac computed tomography (CT) angiography (CCTA) has emerged as a useful diagnostic imaging modality in the assessment of coronary artery disease. However, the potential risks due to exposure to ionizing radiation associated with CCTA have raised concerns. Objectives To estimate the radiation dose of CCTA in routine clinical practice as well as the association of currently available strategies with dose reduction and to identify the independent factors contributing to radiation dose. Design, Setting, and Patients A cross-sectional, international, multicenter, observational study (50 study sites: 21 university hospitals and 29 community hospitals) of estimated radiation dose in 1965 patients undergoing CCTA between February and December 2007. Linear regression analysis was used to identify independent predictors associated with dose. Main Outcome Measure Dose-length product (DLP) of CCTA. Results The median DLP of 1965 CCTA examinations performed at 50 study sites was 885 mGy × cm (interquartile range, 568-1259 mGy × cm), which corresponds to an estimated radiation dose of 12 mSv (or 1.2 x the dose of an abdominal CT study or 600 chest x-rays). A high variability in DLP was observed between study sites (range of median DLPs per site, 331-2146 mGy x cm). Independent factors associated with radiation dose were patient weight (relative effect on DLP, 5%; 95% confidence interval [Cl], 4%-6%), absence of stable sinus rhythm (10%; 95% Cl, 2%-19%), scan length (5%; 95% Cl, 4%-6%), electrocardiographically controlled tube current modulation (-25%; 95% Cl, -23% to -28%; applied in 73% of patients), 100-kV tube voltage (-46%; 95% Cl, -42% to -51 %; applied in 5% of patients), sequential scanning (-78%; 95% Cl, -77% to -79%; applied in 6% of patients), experience in cardiac CT (-1%; 95% Cl, -1 % to 0%), number of CCTAs per month (0%; 95% Cl, 0%-1 %), and type of 64-slice CT system (for highest vs lowest dose system, 97%; 95% Cl, 88%-106%). Algorithms for dose reduction were not associated with deteriorated diagnostic image quality in this observational study. Conclusions Median doses of CCTA differ significantly between study sites and CT systems. Effective strategies to reduce radiation dose are available but some strategies are not frequently used. The comparable diagnostic image quality may support an increased use of dose-saving strategies in adequately selected patients.read more
Citations
More filters
Journal ArticleDOI
Radiation dose associated with common computed tomography examinations and the associated lifetime attributable risk of cancer.
Rebecca Smith-Bindman,Jafi A. Lipson,Ralph Marcus,Kwang Pyo Kim,Mahadevappa Mahesh,Robert G. Gould,Amy Berrington de Gonzalez,Diana L. Miglioretti +7 more
TL;DR: Radiation doses from commonly performed diagnostic CT examinations are higher and more variable than generally quoted, highlighting the need for greater standardization across institutions.
Journal ArticleDOI
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Philip Greenland,Joseph S. Alpert,George A. Beller,Emelia J. Benjamin,Matthew J. Budoff,Zahi A. Fayad,Elyse Foster,Mark A. Hlatky,John McB. Hodgson,Frederick G. Kushner,Michael S. Lauer,Leslee J. Shaw,Sidney C. Smith,Allen J. Taylor,William S. Weintraub,Nanette K. Wenger +15 more
TL;DR: It is essential that the medical profession play a central role in critically evaluating the evidence related to drugs, devices, and procedures for the detection, management, or prevention of disease.
Journal ArticleDOI
Projected cancer risks from computed tomographic scans performed in the United States in 2007.
Amy Berrington de Gonzalez,Mahadevappa Mahesh,Kwang Pyo Kim,Mythreyi Bhargavan,Mythreyi Bhargavan,Rebecca S. Lewis,Fred A. Mettler,Charles E. Land +7 more
TL;DR: These detailed estimates highlight several areas of CT scan use that make large contributions to the total cancer risk, including several scan types and age groups with a high frequency of use or scans involving relatively high doses, in which risk-reduction efforts may be warranted.
Journal ArticleDOI
2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults
Philip Greenland,Joseph S. Alpert,George A. Beller,Emelia J. Benjamin,Matthew J. Budoff,Zahi A. Fayad,Elyse Foster,Mark A. Hlatky,John McB. Hodgson,Frederick G. Kushner,Michael S. Lauer,Leslee J. Shaw,Sidney C. Smith,Allen J. Taylor,William S. Weintraub,Nanette K. Wenger +15 more
TL;DR: A. Alice K. Jacobs, MD, FACC, FAHA, Chair, 2009-2011 as discussed by the authors, and Sidney C. Smith, Jr., MD, FAACC, Immediate Past Chair, 2006-2008 [1]
Journal ArticleDOI
Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures
Reza Fazel,Harlan M. Krumholz,Yongfei Wang,Joseph S. Ross,Jersey Chen,Henry H. Ting,Nilay Shah,Khurram Nasir,Khurram Nasir,Andrew J. Einstein,Andrew J. Einstein,Brahmajee K. Nallamothu,Brahmajee K. Nallamothu +12 more
TL;DR: Imaging procedures are an important source of exposure to ionizing radiation in the United States and can result in high cumulative effective doses of radiation, which increased with advancing age and were higher in women than in men.
References
More filters
Journal ArticleDOI
Estimating Risk of Cancer Associated With Radiation Exposure From 64-Slice Computed Tomography Coronary Angiography
TL;DR: Estimates derived from simulation models suggest that use of 64-slice CTCA is associated with a nonnegligible LAR of cancer, which varies markedly and is considerably greater for women, younger patients, and for combined cardiac and aortic scans.
Journal ArticleDOI
Assessment of coronary artery disease by cardiac computed tomography : A scientific statement from the american heart association committee on cardiovascular imaging and intervention, council on cardiovascular radiology and intervention, and committee on cardiac imaging, council on clinical cardiology
Matthew J. Budoff,Stephan Achenbach,Roger S. Blumenthal,J. Jeffrey Carr,Jonathan G. Goldin,Philip Greenland,Alan D. Guerci,Joao A.C. Lima,Daniel J. Rader,Geoffrey D. Rubin,Leslee J. Shaw,Susan E. Wiegers +11 more
TL;DR: The utility and limitations of generations of cardiac CT systems are reviewed, with emphasis on CT measurement of CAD and coronary artery calcified plaque (CACP) and noncalcified plaque.
Journal ArticleDOI
ACCF/ACR/SCCT/SCMR/ ASNC/NASCI/SCAI/SIR 2006 Appropriateness Criteria for Cardiac Computed Tomography and Cardiac Magnetic Resonance Imaging*
Robert C. Hendel,Manesh R. Patel,Christopher M. Kramer,Michael Poon,James C. Carr,Nancy A. Gerstad,Linda D. Gillam,John McB. Hodgson,Raymond J. Kim,John R. Lesser,Edward T. Martin,Joseph V. Messer,Rita F. Redberg,Geoffrey D. Rubin,John S. Rumsfeld,Allen J. Taylor,Wm. Guy Weigold,Pamela K. Woodard,Ralph G. Brindis,Pamela S. Douglas,Eric D. Peterson,Michael J. Wolk,Joseph M. Allen +22 more
TL;DR: Use of tests for structure and function and for diagnosis in symptomatic, intermediate coronary artery disease (CAD) risk patients was deemed appropriate, while repeat testing and general screening uses were viewed less favorably.