Quality control in quantitative coronary arteriography

  • J. H. C. Reiber
  • J. W. Jukema
  • G. Koning
  • A. V. G. Bruschke
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 180)


The assessment of changes in coronary morphology in lipid intervention trials was carried out initially by visual interpretation on a consensus basis and later by quantitative coronary arteriography (QCA), sometimes supported by visual interpretation. The higher accuracy and precision of the computer-aided approach, however, can only be achieved under highly standardized circumstances. An overview is given on the necessary precautions to be taken regarding:
  1. 1.

    The X-ray and imaging system;

  2. 2.

    The arteriographic image acquisition procedure; and

  3. 3.

    The quantitative image analysis procedure.


For sixteen lipid-intervention trials which were carried out since 1987, it has been checked to what extent nine quality-control issues were applied in these trials. It could be concluded that, as time progressed, trials have conformed increasingly to these standards. However, there is still room for further improvements. Therefore, for new studies, maximal attention should be given to these and other items, not only at the start of the study, but also during the course of the trial.


Modulation Transfer Function Catheterization Laboratory Isosorbide Dinitrate Frame Selection Angiographic View 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Reiber JHC, Serruys PW. Quantitative coronary arteriography. In: Marcus ML, Skorton DJ, Schelben HR, Wolf GL, editors. Cardiac imaging. Philadelphia: W.B. Saunders Company; 1991:221–81.Google Scholar
  2. 2.
    Thompson GR. Progression and regression of coronary artery disease. Curr Opin Lipidol. 1992;3:263–7.CrossRefGoogle Scholar
  3. 3.
    Lespérance J, Waters D. Measuring progression and regression of coronary atherosclerosis in clinical trials: problems and progress. Int J Cardiac Imaging. 1992;8:165–73.CrossRefGoogle Scholar
  4. 4.
    Vos J, Feyter PJ de, Simoons ML, Tijssen JGP, Deckers JW. Retardation and arrest of progression or regression of coronary artery disease: a review. Progr Cardiovasc Dis. 1993;35:435–54.CrossRefGoogle Scholar
  5. 5.
    Reiber JHC, Koning G, Land CD von, Zwet PMJ van der. Why and how should QCA systems be validated? In:Reiber JHC, Serruys PW, editors. Progress in quantitative coronary arteriography. Dordrecht: Kluwer Academic Publishers; 1994:33–48.Google Scholar
  6. 6.
    Eggen DA, Solberg LA. Variation of atherosclerosis with age. Lab Inv. 1968;18:571–9.Google Scholar
  7. 7.
    Jukema JW, Bruschke AVG, Boven AJ van, et al. Effects of lipid lowering by pravastatin on progression and regression of coronary artery disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The ‘Regression Growth Evaluation Statin Study’ (REGRESS). Circulation. 1995;91:2528–40.PubMedGoogle Scholar
  8. 8.
    Lowry RW, Kleiman NS, Raizner AE, Young JB. Is intravascular ultrasound better than quantitative coronary arteriography to assess cardiac allograft arteriopathy? Cath Cardiovasc Diagn. 1994;31:110–15.CrossRefGoogle Scholar
  9. 9.
    Feyter PJ de, Di Mario C, Slager CJ, Serruys PW, Roelandt JRTC. Towards complete assessment of progression/regression of coronary atherosclerosis: implications for intervention trials. In: Reiber JHC, Serruys PW, editors. Progress in quantitative coronary arteriography. Dordrecht: Kluwer Academic Publishers; 1994:295–305.Google Scholar
  10. 10.
    Blankenhorn DH, Brooks SH. Angiographic trials of lipid-lowering therapy. Arteriosclerosis. 1981;1:242–9.Google Scholar
  11. 11.
    Reiber JHC, Land CD von, Koning G, et al. Comparison of accuracy and precision of quantitative coronary arterial analysis between cinefilm and digital systems. In: Reiber JHC, Serruys PW, editors. Progress in quantitative coronary arteriography. Dordrecht: Kluwer Academic Publishers; 1994:67–85.Google Scholar
  12. 12.
    Reiber JHC. An overview of coronary quantitation techniques as of 1989. In: Reiber JHC, Serruys PW, editors. Quantitative coronary arteriography. Dordrecht: Kluwer Academic Publishers; 1991:55–132.CrossRefGoogle Scholar
  13. 13.
    Meijer DJH, van der Zwet PMJ, Reiber JHC. Fully automated PC-based assessment of pincushion distortion. Presented at the 4th International Symposium on Coronary Arteriography, Rotterdam, June 23–25. Abstract book. 1991:180.Google Scholar
  14. 14.
    Buschmeyer L, Onnasch DGW, Heintzen PH. Korrektur magnetfeldbedingter Bildverzeichnungen in bewegten Röntgen-Bildverstärker-Fernseh-Systemen. Biomed Tech. 1989;34:209–10.CrossRefGoogle Scholar
  15. 15.
    Solzbach U, Wollschläger H, Zeiher A, Just H. Optical distortion due to geomagnetism in quantitative angiography. Comput Cardiol. 1989;355–7.Google Scholar
  16. 16.
    Zwet PMJ van der, Meyer DJH, Reiber JHC. Automated and accurate assessment of the distribution, magnitude and direction of pincushion distortion in angiographic images. Invest Radiol. 1995;30:204–13.PubMedCrossRefGoogle Scholar
  17. 17.
    Beauman GJ, Reiber JHC, Koning G, Houdt RCM van, Vogel RA. Angiographic core laboratory analyses of arterial phantom images: comparative evaluations of accuracy and precision. In: Reiber JHC, Serruys PW, editors. Progress in quantitative coronary arteriography. Dordrecht: Kluwer Academic Publishers; 1994:87–104.Google Scholar
  18. 18.
    Wong W-H, Kirkeeide RL, Gould KL. Computer application in angiography. In: Collins SM, Skorton DJ, editors. Cardiac imaging and image processing. New York: McGraw-Hill Book Company; 1986:106–238.Google Scholar
  19. 19.
    Reiber JHC, Zwet PMJ van der, Koning G, et al. Accuracy and precision of quantitative digital coronary arteriography: observer-, short- and medium-term variabilities. Cath Cardiovasc Diagn. 1993;28:187–98.Google Scholar
  20. 20.
    Reiber JHC, Boer A den, Serruys PW. Quality control in performing quantitative coronary arteriography. Am J Cardiac Imaging. 1989;3:172–9.Google Scholar
  21. 21.
    Jost S, Rafflenbeul W, Knop I, et al. Drug plasma levels and coronary vasodilation after isosorbide dinitrate chewing capsules. Eur Heart J. 1989;10(Suppl F):137–41.PubMedGoogle Scholar
  22. 22.
    Feldman RL, Marx JD, Pepine CJ, Conti CR. Analysis of coronary responses to various doses of intracoronary nitroglycerin. Circulation. 1982;66:321–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Gould KL, Martucci JP, Goldberg DI, et al. Short-term cholesterol lowering decreases size and severity of perfusion abnormalities by positron emission tomography after dipyridamole in patients with coronary artery disease. A potential noninvasive marker of healing coronary endothelium. Circulation. 1994;89:1530–8.PubMedGoogle Scholar
  24. 24.
    Cumberland DC. Low-osmolality contrast media in cardiac radiology. Invest Radiol. 1984;19:S301–5.PubMedCrossRefGoogle Scholar
  25. 25.
    Donadieu AM, Hartl C, Cardinal A, Bonnemain B. Incidence of ventricular fibrillation during coronary arteriography in the rabbit. A comparative study of isotonic Ioxaglate and Iohexol. Invest Radiol. 1987;22:106–10.PubMedCrossRefGoogle Scholar
  26. 26.
    Jost S, Rafflenbeul W, Gerhardt U. Influence of ionic and non-ionic radiographic contrast media on the vasomotor tone of epicardial coronary arteries. Eur Heart J. 1989;10(Suppl F):60–5.PubMedGoogle Scholar
  27. 27.
    Koning G, Zwet PMJ van der, Land CD von, Reiber JHC. Angiographic assessment of dimensions of 6F and 7F Mallinckrodt Softouch® coronary contrast catheters from digital and cine arteriograms. Int J Card Imaging. 1992;8:153–61.PubMedCrossRefGoogle Scholar
  28. 28.
    Reiber JHC, Jukema W, Boven A van, Houdt RM van, Lie KI, Bruschke AVG. Catheter sizes for quantitative coronary arteriography. Cath Cardiovasc Diagn. 1994;33:153–5.CrossRefGoogle Scholar
  29. 29.
    Austen WG, Edwards JE, Frye RL, et al. A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association, 1975. Circulation. 1975;51–2:7–40.Google Scholar
  30. 30.
    Blankenhorn DH, Nessim SA, Johnson RL, Sanmarco ME, Azen SP, Cashin-Hemphill L. Beneficial effects of combined colestipol-niacin therapy on coronary atherosclerosis and coronary venous bypass grafts. JAMA. 1987;257:3233–40.PubMedCrossRefGoogle Scholar
  31. 31.
    Brensike JF, Levy RI, Kelsey SF, et al. Effects of therapy with cholestyramine on progression of coronary arteriosclerosis: results of the NHLBI Type II coronary intervention study. Circulation. 1984;69:313–24.PubMedCrossRefGoogle Scholar
  32. 32.
    Buchwald H, Matts JP, Fitch LL, et al. Program on the surgical control of the hyperlipidemias (POSCH): Design and methodology. J Clin Epidemiol. 1989;42:111–27.CrossRefGoogle Scholar
  33. 33.
    Kane JP, Malloy MJ, Ports TA, Phillips NR, Diehl JC, Havel RJ. Regression of coronary atherosclerosis during treatment of familial hypercholesterolemia with combined drug regimens. JAMA. 1990;264:3007–12.PubMedCrossRefGoogle Scholar
  34. 34.
    Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet. 1990;336:129–33.PubMedCrossRefGoogle Scholar
  35. 35.
    Brown BG, Albers JJ, Fisher LD, et al. Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med. 1990;323:1289–98.PubMedCrossRefGoogle Scholar
  36. 36.
    Watts GF, Lewis B, Brunt JNH, et al. Effects on coronary artery disease of lipid-lowering diet, or diet plus cholestyramine, in the St. Thomas’ Atherosclerosis Regression Study (STARS). Lancet. 1992;339:563–9.PubMedCrossRefGoogle Scholar
  37. 37.
    Gibson CM, Sandor T, Stone PH, Pasternak RC, Rosner B, Sacks FM. Quantitative angiographic and statistical methods to assess serial changes in coronary luminal diameter and implications for atherosclerosis regression trials. Am J Cardiol. 1992;69:1286–90.PubMedCrossRefGoogle Scholar
  38. 38.
    Schuler G, Hambrecht R, Schlierf G, et al. Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease. Circulation. 1992;86:1–11.PubMedGoogle Scholar
  39. 39.
    Blankenhorn DH, Azen SP, Kramsch DM, et al. Coronary angiographic changes with lovastatin therapy. The Monitored Atherosclerosis Regression Study (MARS). Ann Intern Med. 1993;119:969–76.PubMedGoogle Scholar
  40. 40.
    Waters D, Higginson L, Gladstone P, et al. Effects of monotherapy with an HMG-CoA reductase inhibitor on the progression of coronary atherosclerosis as assessed by serial quantitative arteriography. The Canadian Coronary Atherosclerosis Intervention Trial. Circulation. 1994;89:959–68.PubMedGoogle Scholar
  41. 41.
    Haskell WL, Alderman EL, Fair JM, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP). Circulation. 1994;89:975–90.PubMedGoogle Scholar
  42. 42.
    Dumont J-M. Effects of cholesterol reduction by simvastatin on progression of coronary atherosclerosis: design, baseline characteristics, and progress of the Multicentre Anti-Atheroma Study (MAAS). Cont Clin Trials. 1993;14:209–28.CrossRefGoogle Scholar
  43. 43.
    Pitt B, Mancini GBJ, Ellis SG, Rosman HS, McGovern ME. Pravastatin limitation of atherosclerosis in the coronary arteries (PLACI). J Am Coll Cardiol. 1994;Feb:131A(Abstract).Google Scholar
  44. 44.
    Brown BG, Bolson E, Frimer M, Dodge HT. Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation. Circulation. 1977;55:329–37.PubMedGoogle Scholar
  45. 45.
    Brown BG, Zhao X-Q, Sacco DE, Albers JJ. Lipid lowering and plaque regression. New insights into prevention of plaque disruption and clinical events in coronary disease. Circulation. 1993;87:1781–91.PubMedGoogle Scholar
  46. 46.
    Selzer RH, Shircore A, Lee PL, Hemphill L, Blankenhorn DH. A second look at quantitative coronary angiography: some unexpected problems. In: Reiber JHC, Serruys PW, editors. State of the art in quantitative coronary arteriography. Dordrecht: Kluwer Academic Publishers; 1986:125–43.Google Scholar
  47. 47.
    Lippolt P, Ehrhardt K, Riedel M, Rafflenbeul W, Lichtlen PR. Variability in quantitative coronary arteriography: higher precision by analysis in consecutive frames. J Am Coll Cardiol. 1994;Feb:209A(Abstract).Google Scholar
  48. 48.
    Syvänne M, Nieminen MS, Frick MH. Accuracy and precision of quantitative arteriography in the evaluation of coronary artery disease after coronary bypass surgery: a validation study. Int J Cardiac Imaging. 1994;10:243–52.CrossRefGoogle Scholar
  49. 49.
    Gerbrands JJ. Segmentation of noisy images. Ph.D. Thesis, Delft University of Technology, 1988.Google Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • J. H. C. Reiber
  • J. W. Jukema
  • G. Koning
  • A. V. G. Bruschke

There are no affiliations available

Personalised recommendations