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European Radiology

, Volume 28, Issue 11, pp 4654–4661 | Cite as

Triple-rule-out CT angiography using two axial scans with 16 cm wide-detector for radiation dose reduction

  • Yuhuan Chen
  • Qi Wang
  • Jianying Li
  • Yongjun Jia
  • Qi Yang
  • Taiping He
Chest
  • 121 Downloads

Abstract

Objective

To explore the use of two consecutive axial scans in triple-rule-out (TRO) examination on a 16 cm wide-detector CT for radiation dose reduction.

Materials and methods

Sixty TRO patients were assigned to either study group (Group A, n = 30) or control group (Group B, n = 30). Group A used a two-phasic contrast injection: 25mgI/kg/s for 12 s in 1st and at 3.0 ml/s injection rate for 7 s in 2nd phase. The pulmonary artery, coronary artery and aorta were scanned in succession with two axial scans using smart-coverage technique. Group B used the conventional protocol of scanning pulmonary arteries first in helical, followed by coronary arteries in axial and aorta in helical mode with contrast injection of 25mgI/kg/s for 14 s. All images were reconstructed with 80% ASIR-V. The qualitative and quantitative image assessment and effective dose of the two groups were statistically compared.

Results

The demographic data and quantitative measurements and qualitative image scores between the two groups were statistically the same (p > 0.05). However, Group A reduced radiation dose by 52% (2.67 ± 0.98 mSv vs. 5.65 ± 1.37 mSv) (p < 0.001).

Conclusion

Using two consecutive axial scans in triple-rule-out on a 16 cm wide-detector CT reduces radiation dose while maintaining image quality compared with the conventional TRO protocol.

Key Points

• Triple-rule-out can be performed with two-axial scans on a wide-detector CT system.

• TRO with two-axial scans maintain image quality compared with conventional protocol.

• TRO with two-axial scans reduces 52% radiation dose over conventional protocol.

Keywords

Chest pain Radiation dosage Diagnostic imaging Computed tomography angiography Tomography, X-ray computed 

Abbreviations

ACS

Acute coronary syndrome

AD

Aortic dissection

ASIR

Adaptive statistical iterative reconstruction

CNR

Contrast-to-noise ratio

CTA

Computed tomography angiography

CTDI

CT dose index

DFOV

Display field of view

DLP

Dose-length product

MIP

Maximum intensity projection

mSv

Millisievert

PTE

Pulmonary thromboembolism

ROI

Region-of-interest

SD

Standard deviation

SSF

Snapshot freeze

TRO

Triple-rule-out

VR

Volume rendering

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Taiping He.

Conflict of interest

The authors of this manuscript declare no conflict of interest exits in the submission of this manuscript.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• randomized controlled trial

• performed at one institution

References

  1. 1.
    Wnorowski AM, Halpern EJ (2016) Diagnostic yield of triple-rule-out CT in an emergency setting. AJR Am J Roentgenol 207(2):295–301CrossRefGoogle Scholar
  2. 2.
    Kim HS, Kim SM, Cha MJ et al (2017) Triple rule-out CT angiography protocol with restricting field of view for detection of pulmonary thromboembolism and aortic dissection in emergency department patients: simulation of modified CT protocol for reducing radiation dose. Acta Radiol 58(5):521–527CrossRefGoogle Scholar
  3. 3.
    Manheimer ED, Peters MR, Wolff SD et al (2011) Comparison of radiation dose and image quality of triple-rule-out computed tomography angiography between conventional helical scanning and a strategy incorporating sequential scanning. Am J Cardiol 107(7):1093–1098CrossRefGoogle Scholar
  4. 4.
    Ayaram D, Bellolio MF, Murad MH et al (2013) Triple rule-out computed tomographic angiography for chest pain: a diagnostic systematic review and meta-analysis. Acad Emerg Med 20(9):861–871CrossRefGoogle Scholar
  5. 5.
    Krissak R, Henzler T, Prechel A et al (2012) Triple-rule-out dual-source CT angiography of patients with acute chest pain: dose reduction potential of 100 kV scanning. Eur J Radiol 81(12):3691–3696CrossRefGoogle Scholar
  6. 6.
    Mayo JR, Aldrich J, Muller NL et al (2003) Radiation exposure at chest CT: a statement of the Fleischner society. Radiology 228(1):15–21CrossRefGoogle Scholar
  7. 7.
    Andreini D, Pontone G, Mushtaq S et al (2017) Image quality and radiation dose of coronary CT angiography performed with whole-heart coverage CT scanner with intra-cycle motion correction algorithm in patients with atrial fibrillation. Eur Radiol.  https://doi.org/10.1007/s00330-017-5131-2 CrossRefGoogle Scholar
  8. 8.
    Wong DTL, Soh SY, Ko BS et al (2014) Superior CT coronary angiography image quality at lower radiation exposure with second generation 320-detector row CT in patients with elevated heart rate: a comparison with first generation 320-detector row CT. Cardiovasc Diagn Ther 4(4):299–306PubMedPubMedCentralGoogle Scholar
  9. 9.
    Hong C, Becker CR, Huber A et al (2001) ECG-gated reconstructed multi-detector row CT coronary angiography: effect of varying trigger delay on image quality. Radiology 220(3):712–717CrossRefGoogle Scholar
  10. 10.
    European guideline on quality criteria for computed tomography (1999) Brussels, Belgium Report EUR 16262 ENGoogle Scholar
  11. 11.
    Frauenfelder T, Appenzeller P, Karlo C et al (2009) Triple rule-out CT in the emergency department: protocols and spectrum of imaging findings. Eur Radiol 19:789–799CrossRefGoogle Scholar
  12. 12.
    Messerli M, Dewes P, Scholtz J et al (2017) Evaluation of an adaptive detector collimation for prospectively ECG-triggered coronary CT angiography with third-generation dual-source CT. Eur Radiol.  https://doi.org/10.1007/s00330-017-5177-1 CrossRefGoogle Scholar
  13. 13.
    Hou DJ, Tso DK, Davison C et al (2013) Clinical utility of ultra high pitch dual source thoracic CT imaging of acute pulmonary embolism in the emergency department: are we one step closer towards a non-gated triple rule out? Eur J Radiol 82(10):1793–1798CrossRefGoogle Scholar
  14. 14.
    Sommer WH, Schenzle JC, Becker CR et al (2009) Saving dose in triple-rule-out computed tomography examination using a high-pitch dual spiral technique. Invest Radiol 45:64–71CrossRefGoogle Scholar
  15. 15.
    Halpern EJ, Levin DC, Zhang S et al (2009) Comparison of image quality and arterial enhancement with a dedicated coronary CTA protocol versus a triple rule-out coronary CTA protocol. Acad Radiol 16(9):1039–1048CrossRefGoogle Scholar
  16. 16.
    Burris AC, Boura JA, Raff GL (2015) Triple rule out versus coronary CT angiography in patients with acute chest pain: results from the ACIC consortium. J Am Coll Cardiol Img 8(7):817–825CrossRefGoogle Scholar
  17. 17.
    Takx RAP, Krissak R, Fink C et al (2017) Low-tube-voltage selection for triple-rule-out CTA: relation to patient size. Eur Radiol 27(6):1–6CrossRefGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  1. 1.Shaanxi University of Traditional Chinese MedicineXianyangChina
  2. 2.Department of RadiologyAffiliated Hospital of Shaanxi Chinese Medicine UniversityXianyangChina
  3. 3.Department of RadiologyChang’an HospitalXi’anChina
  4. 4.CT Research Center, GE Healthcare ChinaWuxiChina

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