Advertisement

European Radiology

, Volume 28, Issue 7, pp 2756–2762 | Cite as

Using coronary CT angiography for guiding invasive coronary angiography: potential role to reduce intraprocedural radiation exposure

  • Christophe T. Arendt
  • Patricia Tischendorf
  • Julian L. Wichmann
  • Michael Messerli
  • Lucas Jörg
  • Niklas Ehl
  • Robin F. Gohmann
  • Simon Wildermuth
  • Thomas J. Vogl
  • Ralf W. BauerEmail author
Computed Tomography
  • 215 Downloads

Abstract

Objectives

We investigated the potential reduction of patient exposure during invasive coronary angiography (ICA) if the procedure had only been directed to the vessel with at least one ≥ 50% stenosis as described in the CT report.

Methods

Dose reports of 61 patients referred to ICA because of at least one ≥ 50% stenosis on coronary CT angiography (CCTA) were included. Dose–area product (DAP) was documented separately for left (LCA) and right coronary arteries (RCA) by summing up the single DAP for each angiographic projection. The study population was subdivided as follows: coronary intervention of LCA (group 1) or RCA (group 2) only, or of both vessels (group 3), or further bypass grafting (group 4), or no further intervention (group 5).

Results

57.4% of the study population could have benefitted from reduced exposure if catheterization had been directly guided to the vessel of interest as described on CCTA. Mean relative DAP reductions were as follows: group 1 (n = 18), 11.2%; group 2 (n = 2), 40.3%; group 3 (n = 10), 0%; group 4 (n = 3), 0%; group 5 (n = 28), 28.8%.

Conclusions

Directing ICA to the vessel with stenosis as described on CCTA would reduce intraprocedural patient exposure substantially, especially for patients with single-vessel stenosis.

Key points

• Patients with CAD can benefit from decreased radiation exposure during coronary angiography.

• ICA should be directed solely to significant stenoses as described on CCTA.

• Severely calcified plaques remain a limitation of CCTA leading to unnecessary ICA referrals.

Keywords

Coronary vessels Coronary artery disease Coronary angiography Computed tomography angiography Radiation exposure 

Abbreviations

CABG

Coronary artery bypass grafting

CAD

Coronary artery disease

CCTA

Coronary computed tomography angiography

DAP

Dose–area product

DLP

Dose–length product

FFR

Fractional flow reserve

ICA

Invasive coronary angiography

LCA

Left coronary artery

PCI

Percutaneous coronary intervention

RCA

Right coronary artery

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 Ralf W. Bauer.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

Ralf W. Bauer is on the speakers’ bureau of Siemens Healthcare, Bayer Healthcare and GE Healthcare. Julian L. Wichmann received speakers’ fees from Siemens Healthcare and GE Healthcare.

Statistics and biometry

One of the authors has significant statistical expertise.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

References

  1. 1.
    Taylor AJ, Cerqueira M, Hodgson JM et al (2010) ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Cardiovasc Comput Tomogr 4:407 e1–407 33Google Scholar
  2. 2.
    von Ballmoos MW, Haring B, Juillerat P, Alkadhi H (2011) Meta-analysis: diagnostic performance of low-radiation-dose coronary computed tomography angiography. Ann Intern Med 154:413–420CrossRefGoogle Scholar
  3. 3.
    Kim HY, Choi JH (2015) How to utilize coronary computed tomography angiography in the treatment of coronary artery disease. J Cardiovasc Ultrasound 23:204–208CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    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 34:2949–3003CrossRefPubMedGoogle Scholar
  5. 5.
    Teunen D (1998) The European Directive on health protection of individuals against the dangers of ionising radiation in relation to medical exposures (97/43/EURATOM). J Radiol Prot 18:133–137CrossRefPubMedGoogle Scholar
  6. 6.
    Ghoshhajra BB, Engel LC, Major GP et al (2012) Evolution of coronary computed tomography radiation dose reduction at a tertiary referral center. Am J Med 125:764–772CrossRefPubMedGoogle Scholar
  7. 7.
    De Cecco CN, Meinel FG, Chiaramida SA, Costello P, Bamberg F, Schoepf UJ (2014) Coronary artery computed tomography scanning. Circulation 129:1341–1345CrossRefPubMedGoogle Scholar
  8. 8.
    Achenbach S, Marwan M, Ropers D et al (2010) Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J 31:340–346CrossRefPubMedGoogle Scholar
  9. 9.
    Bogaert E, Bacher K, Thierens H (2008) A large-scale multicentre study in Belgium of dose area product values and effective doses in interventional cardiology using contemporary X-ray equipment. Radiat Prot Dosimetry 128:312–323CrossRefPubMedGoogle Scholar
  10. 10.
    Betsou S, Efstathopoulos EP, Katritsis D, Faulkner K, Panayiotakis G (1998) Patient radiation doses during cardiac catheterization procedures. Br J Radiol 71:634–639CrossRefPubMedGoogle Scholar
  11. 11.
    Picano E, Santoro G, Vano E (2007) Sustainability in the cardiac cath lab. Int J Cardiovasc Imaging 23:143–147CrossRefPubMedGoogle Scholar
  12. 12.
    Goldstein JA, Balter S, Cowley M, Hodgson J, Klein LW (2004) Occupational hazards of interventional cardiologists: prevalence of orthopedic health problems in contemporary practice. Catheter Cardiovasc Interv 63:407–411CrossRefPubMedGoogle Scholar
  13. 13.
    Andreassi MG, Piccaluga E, Guagliumi G, Del Greco M, Gaita F, Picano E (2016) Occupational health risks in cardiac catheterization laboratory workers. Circ Cardiovasc Interv 9:e003273PubMedGoogle Scholar
  14. 14.
    Rajiah P, Schoenhagen P (2013) The role of computed tomography in pre-procedural planning of cardiovascular surgery and intervention. Insights Imaging 4:671–689CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Patel MR, Bailey SR, Bonow RO et al (2012) ACCF/SCAI/AATS/AHA/ASE/ASNC/HFSA/HRS/SCCM/SCCT/SCMR/STS 2012 appropriate use criteria for diagnostic catheterization: a report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, Heart Rhythm Society, Society of Critical Care Medicine, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons. J Am Coll Cardiol 59:1995–2027CrossRefPubMedGoogle Scholar
  16. 16.
    Plank F, Friedrich G, Dichtl W et al (2014) The diagnostic and prognostic value of coronary CT angiography in asymptomatic high-risk patients: a cohort study. Open Heart 1:e000096CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Arbab-Zadeh A, Miller JM, Rochitte CE et al (2012) Diagnostic accuracy of computed tomography coronary angiography according to pre-test probability of coronary artery disease and severity of coronary arterial calcification. The CORE-64 (Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography) International Multicenter Study. J Am Coll Cardiol 59:379–387CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Budoff MJ, Dowe D, Jollis JG et al (2008) Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 52:1724–1732CrossRefPubMedGoogle Scholar
  19. 19.
    Carrascosa P, Capunay C, Deviggiano A et al (2010) Accuracy of low-dose prospectively gated axial coronary CT angiography for the assessment of coronary artery stenosis in patients with stable heart rate. J Cardiovasc Comput Tomogr 4:197–205CrossRefPubMedGoogle Scholar
  20. 20.
    Mangold S, Wichmann JL, Schoepf UJ et al (2017) Diagnostic accuracy of coronary CT angiography using 3rd-generation dual-source CT and automated tube voltage selection: Clinical application in a non-obese and obese patient population. Eur Radiol 27:2298–2308CrossRefPubMedGoogle Scholar
  21. 21.
    Engel LC, Thai WE, Medina-Zuluaga H et al (2017) Non-diagnostic coronary artery calcification and stenosis: a correlation of coronary computed tomography angiography and invasive coronary angiography. Acta Radiol 58:528–536CrossRefPubMedGoogle Scholar
  22. 22.
    Dey D, Lee CJ, Ohba M et al (2008) Image quality and artifacts in coronary CT angiography with dual-source CT: initial clinical experience. J Cardiovasc Comput Tomogr 2:105–114CrossRefPubMedGoogle Scholar
  23. 23.
    Andrew M, John H (2015) The challenge of coronary calcium on coronary computed tomographic angiography (CCTA) scans: effect on interpretation and possible solutions. Int J Cardiovasc Imaging 31:145–157CrossRefPubMedGoogle Scholar
  24. 24.
    Compagnone G, Ortolani P, Domenichelli S et al (2011) Effective and equivalent organ doses in patients undergoing coronary angiography and percutaneous coronary intervention. Med Phys 38:2168–2175CrossRefPubMedGoogle Scholar
  25. 25.
    Kerl JM, Schoepf UJ, Zwerner PL et al (2011) Accuracy of coronary artery stenosis detection with CT versus conventional coronary angiography compared with composite findings from both tests as an enhanced reference standard. Eur Radiol 21:1895–1903CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Christophe T. Arendt
    • 1
  • Patricia Tischendorf
    • 1
  • Julian L. Wichmann
    • 1
  • Michael Messerli
    • 2
    • 3
  • Lucas Jörg
    • 4
  • Niklas Ehl
    • 4
  • Robin F. Gohmann
    • 5
  • Simon Wildermuth
    • 2
  • Thomas J. Vogl
    • 1
  • Ralf W. Bauer
    • 6
    Email author
  1. 1.Institute for Diagnostic and Interventional RadiologyClinic of the Goethe UniversityFrankfurtGermany
  2. 2.Clinic for Radiology and Nuclear MedicineCantonal Hospital St. GallenSt. GallenSwitzerland
  3. 3.Department of Nuclear Medicine, Cardiac ImagingUniversity Hospital ZurichZürichSwitzerland
  4. 4.Clinic for Cardiology, Medical Department ICantonal Hospital St. GallenSt. GallenSwitzerland
  5. 5.Clinic for Diagnostic and Interventional RadiologyRWTH University Hospital AachenAachenGermany
  6. 6.RNS Gemeinschaftspraxis GbR, Private Radiology and Radiation Therapy GroupWiesbadenGermany

Personalised recommendations