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Declining radiation dose of coronary computed tomography angiography: German cardiac CT registry experience 2009–2014

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Abstract

Background

Coronary computed tomography angiography (CTA) is increasingly used as a test to rule out coronary artery disease (CAD) in patients with a low to intermediate pre-test probability of the disease. We used the database of the German CT registry, collected between 2009 and 2014 in a broad patient population, to analyze contemporary radiation dose associated with coronary CTA in clinical practice.

Patients and methods

The prospective observational registry included a total of 7061 patients ≥18 years, referred to 12 participating centers for a clinically indicated cardiac CT examination. All centers were cardiology units well experienced in CTA and used multi-slice CT scanners with at least 64 rows. Coronary CTA was performed in a subset of 5001 patients, 59.6 ± 11.8 years, body mass index (BMI) 26.9 ± 4.5 kg/m2, 38% females. Three time periods with approximately equal numbers of patients were created (01/09–03/10, 04/10–03/11, 04/11–07/14). The dose–length product of all examinations and derived effective dose in mSv (conversion factor k = 0.014) as well as the influence of patient characteristics on dose were compared for the three time periods.

Results

BMI and proportion of female patients remained stable over time, and mean heart rate decreased from 60.3 ± 9.0 to 58.5 ± 9.3 bpm from the first to the last time period (p < 0.001). Overall, the mean effective dose of coronary CTA was 3.6 mSv (Q1 1.8 mSv, Q3 7.4 mSv). Within the three time periods, it declined from 5.6 (2.7, 8.6) mSv during the first to 4.8 (2.1, 8.2) mSv during the second and 2.5 (1.3, 4.6) mSv during the last time period (p < 0.001). Paralleling the decline in radiation dose over time, the proportion of prospectively ECG-triggered examinations increased (68, 79, 83%; p < 0.001), and the proportion of examinations with retrospective gating and no tube current modulation decreased (5.3, 4.0, 1.6%; p < 0.001). Tube current (mAs) and voltage (kV) both decreased over time. In multivariable analysis, besides earlier time period, further independent predictors of an increased radiation dose were older age, higher heart rate, and higher BMI as well as the technical factors higher mAs, higher kV, and retrospective gating. At three sites, CT scanners with improved technology were installed during the last time period.

Conclusions

In current clinical practice among German cardiology units with specific expertise in cross-sectional cardiovascular imaging, overall radiation dose of coronary CTA was comparably low. Over time, a decline in radiation dose was demonstrated, probably due to a combination of improvements in data acquisition protocols and patient preparation as well as installation of new CT scanners with advanced technology.

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References

  1. Montalescot G, Sechtem U, Achenbach S et al (2013) 2013 ESC guidelines on the management of stable coronary artery disease: the Task Force on the management of stable coronary artery disease of the European Society of Cardiology. Eur Heart J 34:2949–3003 (erratum in: Eur Heart J 2014;35:2260–2261)

    Article  PubMed  Google Scholar 

  2. Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ (2007) Radiation dose to patients from cardiac imaging. Circulation 116:1290–1305

    Article  PubMed  Google Scholar 

  3. Einstein AJ, Henzlova MJ, Rajagopalan S (2007) Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA 298:317–323

    Article  CAS  PubMed  Google Scholar 

  4. Gerber TC, Carr JJ, Arai AE et al (2009) Ionizing radiation in cardiac imaging. science advisory from the American Heart Association Committee on Cardiac Imaging of the Council on Clinical Cardiology and Committee on Cardiovascular Imaging and Intervention of the Council on Cardiovascular Radiology and Intervention. Circulation 119:1056–1065

    Article  PubMed  Google Scholar 

  5. Hausleiter J, Meyer T, Hermann F et al (2009) Estimated radiation dose associated with cardiac CT angiography. JAMA 301:500–507

    Article  CAS  PubMed  Google Scholar 

  6. Hunold P, Voigt FM, Schmermund A et al (2003) Radiation exposure during cardiac CT: effective doses at multi-detector row CT and electron-beam CT. Radiology 226:145–152

    Article  PubMed  Google Scholar 

  7. Perrin M, Djaballah W, Moulin F et al (2015) Stress-first protocol for myocardial perfusion SPECT imaging with semiconductor cameras: high diagnostic performances with significant reduction in patient radiation doses. Eur J Nucl Med Mol Imaging 42:1004–1011

    Article  CAS  PubMed  Google Scholar 

  8. Hell MM, Bittner D, Schuhbäck A et al (2014) Prospectively ECG-triggered high-pitch coronary angiography with third-generation dual-source CT at 70 kVp tube voltage: feasibility, image quality, radiation dose, and effect of iterative reconstruction. J Cardiovasc Comput Tomogr 8:418–425

    Article  PubMed  Google Scholar 

  9. Bongartz G, Golding SJ, Jurik AG et al (2004) European guidelines for multislice computed tomography. Funded by the European Commission. Contract number FIGM-CT2000-20078-CT-TIP, March 2004. http://www.msct.eu/CT_Quality_Criteria.htm. Accessed 19 Oct 2016

  10. SCOT-HEART investigators (2015) CT coronary angiography in patients with suspected angina due to coronary heart disease (SCOT-HEART): an open-label, parallel-group, multicentre trial. Lancet 385:2383–2391 (erratum in: Lancet 2015;385:2354)

    Article  Google Scholar 

  11. Husmann L, Herzog BA, Burger IA et al (2010) Usefulness of additional coronary calcium scoring in low-dose CT coronary angiography with prospective ECG-triggering impact on total effective radiation dose and diagnostic accuracy. Acad Radiol 17:201–206

    Article  PubMed  Google Scholar 

  12. Marwan M, Mettin C, Pflederer T et al (2013) Very low-dose coronary artery calcium scanning with high-pitch spiral acquisition mode: comparison between 120-kV and 100-kV tube voltage protocols. J Cardiovasc Comput Tomogr 7:32–38

    Article  PubMed  Google Scholar 

  13. Poll LW, Cohnen M, Brachten S, Ewen K, Mödder U (2002) Dose reduction in multi-slice CT of the heart by use of ECG-controlled tube current modulation (“ECG pulsing”): phantom measurements. Rofo 174:1500–1505

    Article  CAS  PubMed  Google Scholar 

  14. Gerber TC, Stratmann BP, Kuzo RS, Kantor B, Morin RL (2005) Effect of acquisition technique on radiation dose and image quality in multidetector row computed tomography coronary angiography with submillimeter collimation. Invest Radiol 40:556–563

    Article  PubMed  Google Scholar 

  15. Gopal A, Mao SS, Karlsberg D et al (2009) Radiation reduction with prospective ECG-triggering acquisition using 64-multidetector computed tomographic angiography. Int J Cardiovasc Imaging 25:405–416

    Article  PubMed  Google Scholar 

  16. Arnoldi E, Johnson TR, Rist C et al (2009) Adequate image quality with reduced radiation dose in prospectively triggered coronary CTA compared with retrospective techniques. Eur Radiol 19:2147–2155

    Article  PubMed  Google Scholar 

  17. European Commission In: De Cort M, Tollefsen T, Marsano A, Gitzinger C (eds) EUR 23950—environmental radioactivity in the european community 2004–2006. Office for Official Publications of the European Communities 2009, Luxembourg. https://rem.jrc.ec.europa.eu/RemWeb/Reports.aspx, Accessed 23 Oct 2016

  18. Erbel R, Budoff M (2012) Improvement of cardiovascular risk prediction using coronary imaging: subclinical atherosclerosis, the memory of lifetime risk factor exposure. Eur Heart J 33:1201–1213

    Article  PubMed  Google Scholar 

  19. Löwel H, Meisinger C, Heier M, Hörmann A, von Scheidt W (2005) Herzinfarkt und koronare Sterblichkeit in Süddeutschland. Deutsches Ärzteblatt 103:A616–A622

    Google Scholar 

  20. Piepoli MF, Hoes AW, Agewall S et al (2016) 2016 European guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in clinical practice (constituted by representatives of 10 societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 37:2315–2381

    Article  PubMed  PubMed Central  Google Scholar 

  21. Opolski MP, Kim WK, Liebetrau C et al (2015) Diagnostic accuracy of computed tomography angiography for the detection of coronary artery disease in patients referred for transcatheter aortic valve implantation. Clin Res Cardiol 104:471–480

    Article  PubMed  Google Scholar 

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Acknowledgements

Funding was provided by Stiftung Institut für Herzinfarktforschung, Ludwigshafen.

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Authors and Affiliations

  1. Cardioangiologisches Centrum Bethanien, CCB, Im Prüfling 23, 60389, Frankfurt Am Main, Germany

    Axel Schmermund

  2. Friedrich-Alexander-Universität Erlangen, Erlangen, Germany

    Mohamed Marwan & Stephan Achenbach

  3. Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, Munich, Germany

    Jörg Hausleiter

  4. Herz- und Gefäß-Klinik, Rhön-Klinikum Bad Neustadt an der Saale, Bad Neustadt an Der Saale, Germany

    Sebastian Barth & Sebastian Kerber

  5. Klinik für Kardiologie und Angiologie, Contilia Herz- und Gefäßzentrum, Elisabeth-Krankenhaus Essen, Essen, Germany

    Oliver Bruder

  6. Medizinische Klinik (Krehl-Klinik) und Klinik für Kardiologie, Angiologie und Pneumologie (Innere Medizin III), Universitätsklinikum Heidelberg, Heidelberg, Germany

    Grigorius Korosoglou

  7. Kardiologie und Angiologie, GRN-Klinik Weinheim, Weinheim, Germany

    Grigorius Korosoglou

  8. Isar Herz Zentrum München, Munich, Germany

    Alexander Leber

  9. Kardiologie Klinikum Traunstein, Traunstein, Germany

    Werner Moshage

  10. Klinik für Kardiologie, Pneumologie und Angiologie mit Schlaganfallstation, Internistische Sportmedizin, Alb Fils Klinik am Eichert, Göppingen, Germany

    Stephen Schröder

  11. Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany

    Steffen Schneider & Jochen Senges

Authors
  1. Axel Schmermund
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  2. Mohamed Marwan
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  3. Jörg Hausleiter
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  6. Sebastian Kerber
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  7. Grigorius Korosoglou
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  8. Alexander Leber
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  9. Werner Moshage
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  11. Steffen Schneider
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  12. Jochen Senges
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  13. Stephan Achenbach
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Corresponding author

Correspondence to Axel Schmermund.

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Conflict of interest

Axel Schmermund, Mohamed Marwan, and Stephan Achenbach have received speaker honoraria from Siemens Healthineers Deutschland, manufacturer of cardiac CT machines.

Appendix

Appendix

Centers participating in the German cardiac CT registry in alphabetical order:

  • Cardioangiologisches Centrum Bethanien, Frankfurt,

  • Deutsches Herzzentrum, Munich,

  • Elisabeth Krankenhaus Essen,

  • Herzzentrum Bogenhausen, Munich,

  • Kerckhoff Klinik, Bad Nauheim,

  • Klinikum am Eichert, Göppingen,

  • Klinikum Ludwigshafen,

  • Klinikum Traunstein,

  • Universitätsklinikum Erlangen,

  • Universitätsklinikum Gießen,

  • Universitätsklinikum Heidelberg,

  • Universitätsklinikum Tübingen.

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Schmermund, A., Marwan, M., Hausleiter, J. et al. Declining radiation dose of coronary computed tomography angiography: German cardiac CT registry experience 2009–2014. Clin Res Cardiol 106, 905–912 (2017). https://doi.org/10.1007/s00392-017-1136-8

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  • DOI: https://doi.org/10.1007/s00392-017-1136-8

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