European Radiology

, Volume 22, Issue 3, pp 569–578 | Cite as

Radiation dose considerations by intra-individual Monte Carlo simulations in dual source spiral coronary computed tomography angiography with electrocardiogram-triggered tube current modulation and adaptive pitch

  • Matthias S. MayEmail author
  • Paul Deak
  • Axel Kuettner
  • Michael M. Lell
  • Wolfgang Wuest
  • Michael Scharf
  • Andrea K. Keller
  • Lothar Häberle
  • Stephan Achenbach
  • Martin Seltmann
  • Michael Uder
  • Willi A. Kalender



To evaluate radiation dose levels in patients undergoing spiral coronary computed tomography angiography (CTA) on a dual-source system in clinical routine.


Coronary CTA was performed for 56 patients with electrocardiogram-triggered tube current modulation (TCM) and heart-rate (HR) dependent pitch adaptation. Individual Monte Carlo (MC) simulations were performed for dose assessment. Retrospective simulations with constant tube current (CTC) served as reference. Lung tissue was segmented and used for organ and effective dose (ED) calculation.


Estimates for mean relative ED was 7.1 ± 2.1 mSv/100 mAs for TCM and 12.5 ± 5.3 mSv/100 mAs for CTC (P < 0.001). Relative dose reduction at low HR (≤60 bpm) was highest (49 ± 5%) compared to intermediate (60–70 bpm, 33 ± 12%) and high HR (>70 bpm, 29 ± 12%). However lowest ED is achieved at high HR (5.2 ± 1.5 mSv/100 mAs), compared with intermediate (6.7 ± 1.6 mSv/100 mAs) and low (8.3 ± 2.1 mSv/100 mAs) HR when automated pitch adaptation is applied.


Radiation dose savings up to 52% are achievable by TCM at low and regular HR. However lowest ED is attained at high HR by pitch adaptation despite inferior radiation dose reduction by TCM.

Key Points

Monte Carlo simulations allow for individual radiation dose calculations.

ECG-triggered tube current modulation (TCM) can effectively reduce radiation dose.

Slow and regular heart rates allow for highest dose reductions by TCM.

Adaptive pitch accounts for lowest radiation dose at high heart rates.

Women receive higher effective dose than men undergoing spiral coronary CT-angiography.


Dual source computed tomography ECG-pulsing Adaptive pitch Coronary angiography Monte Carlo radiation dose simulation 



We are grateful to Werner Bautz, Katharina Anders and Gerd Muschiol for their support in the clinical investigation and Marcel von Straten for his technical support in running the Monte Carlo simulations and providing the dose estimations. This study was supported by the German Government, Bundesministerium für Bildung und Forschung (01EX1012B, “Spitzencluster Medical Valley”).


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Copyright information

© European Society of Radiology 2011

Authors and Affiliations

  • Matthias S. May
    • 1
    Email author
  • Paul Deak
    • 2
  • Axel Kuettner
    • 1
  • Michael M. Lell
    • 1
  • Wolfgang Wuest
    • 1
  • Michael Scharf
    • 1
  • Andrea K. Keller
    • 3
  • Lothar Häberle
    • 3
  • Stephan Achenbach
    • 4
  • Martin Seltmann
    • 4
  • Michael Uder
    • 1
  • Willi A. Kalender
    • 2
  1. 1.Department of RadiologyUniversity of ErlangenErlangenGermany
  2. 2.Department of Medical PhysicsUniversity of ErlangenErlangenGermany
  3. 3.Department of Medical Informatics, Biometry and EpidemiologyUniversity of ErlangenErlangenGermany
  4. 4.Department of CardiologyUniversity of ErlangenErlangenGermany

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