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



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.


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).


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%.


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.


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



Coronary artery bypass grafting


Coronary artery disease


Coronary computed tomography angiography


Dose–area product


Dose–length product


Fractional flow reserve


Invasive coronary angiography


Left coronary artery


Percutaneous coronary intervention


Right coronary artery



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

Compliance with ethical standards


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.


• retrospective

• observational

• performed at one institution


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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

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