In vivo radiation dosimetry and image quality of turbo-flash and retrospective dual-source CT coronary angiography

  • Nicolò Schicchi
  • Alberto Mari
  • Marco FoganteEmail author
  • Paolo Esposto Pirani
  • Giacomo Agliata
  • Niccolò Tosi
  • Pierpaolo Palumbo
  • Ester Cannizzaro
  • Federico Bruno
  • Alessandra Splendiani
  • Ernesto Di Cesare
  • Stefania Maggi
  • Andrea Giovagnoni



To compare measured radiation dose (MD), estimated radiation dose (ED) and image quality in coronary computed tomography between turbo-flash (TFP) and retrospective protocol (RP) and correlate MD with size-specific dose estimates (SSDE).

Materials and methods

In this prospective study, we selected 68 patients (mean age, 59.2 ± 9.7 years) undergoing 192 × 2 dual-source CT (SOMATOM Force, Siemens) to rule out coronary artery disease. Thirty-one underwent TFP and 37 RP. To evaluate in vivo MD, thermoluminescent dosimeters were placed, superficially, at thyroid and heart level, left breast areola and left hemi-thorax. MD in each site, and ED parameters, such as volume CT dose index (CTDIvol), SSDE, dose length product (DLP), effective dose (E), were compared between two protocols with a t test. Image quality was compared between two protocols. Inter-observer agreement was evaluated with a kappa coefficient (k). In each protocol, MD was correlated with SSDE using a Pearson coefficient (r).


Comparing TFP and RP, MD at thyroid (1.43 vs. 2.58 mGy; p = 0.0408), heart (3.58 vs. 28.72 mGy; p < 0.0001), left breast areola (3.00 vs. 24.21 mGy; p < 0.0001) and left hemi-thorax (2.68 vs. 24.03 mGy; p < 0.0001), CTDIvol, SSDE, DLP and E were significantly lower. Differences in image quality were not statistically significant. Inter-observer agreement was good (k = 0.796) in TFP and very good (k = 0.817) in RP. MD and SSDE excellently correlated with TFP (r = 0.9298, p < 0.0001) and RP (r = 0.9753, p < 0.0001).


With TFP, MD, CTDIvol, SSDE, DLP and E were significantly lower, than with RP. Image quality was similar between two protocols. MD correlated excellently with SSDE in each protocol.


In vivo radiation dose Estimated radiation dose Coronary CT Dual-source CT 

List of abbreviations


Ascending aorta


Coronary artery disease


Coronary computed tomography


Contrast medium


Contrast-to-noise ratio


Volume computed tomography dose index


Dose length product


Dual source


Effective dose




Estimated dose


Image noise


Left anterior descending artery


Left circumflex artery


Left main coronary artery


Measured dose


Right coronary artery


Radiation dose


Region of interest


Retrospective protocol


Standard deviation


Signal-to-noise ratio


Size-specific dose estimate


Thermoluminescent dosimeter


Turbo-flash protocol



This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Compliance with ethical standard

Conflict of interest

The authors declared no potential conflicts of interests associated with this study.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study. Institutional review board approved the study.


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Copyright information

© Italian Society of Medical Radiology 2019

Authors and Affiliations

  • Nicolò Schicchi
    • 1
  • Alberto Mari
    • 2
  • Marco Fogante
    • 1
    Email author
  • Paolo Esposto Pirani
    • 1
  • Giacomo Agliata
    • 1
  • Niccolò Tosi
    • 1
  • Pierpaolo Palumbo
    • 3
  • Ester Cannizzaro
    • 3
  • Federico Bruno
    • 3
  • Alessandra Splendiani
    • 3
  • Ernesto Di Cesare
    • 3
  • Stefania Maggi
    • 2
  • Andrea Giovagnoni
    • 1
  1. 1.Radiology DepartmentAzienda Ospedaliero Universitaria “Ospedali Riuniti”AnconaItaly
  2. 2.Health Physics DepartmentAzienda Ospedaliero Universitaria “Ospedali Riuniti”AnconaItaly
  3. 3.Life, Health and Environmental Sciences DepartmentUniversity of L’AquilaL’AquilaItaly

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