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Keywords:
Cardiac, Radioprotection / Radiation dose, Radiation physics, CT, CT-Angiography, Dosimetry, Equipment, Radiation safety, Dosimetric comparison, Education and training
Authors:
F. Mafalanka1, J.-L. Rehel1, D. Pesenti-Rossi2, L.-P. Christiaens3, R. Convers-Domart4, P. Ou5, E. Schouman-Claeys5, M. Sirol5, C. Etard1; 1Fontenay-aux-Roses/FR, 2Neuilly-sur-Seine/FR, 3Poitiers/FR, 4Le Chesnay/FR, 5Paris/FR
DOI:
10.1594/ecr2014/B-0779
Purpose
Coronary computed tomography angiography (CCTA) has evolved to an unprecedented rate during the last decade.
It has become an effective and accurate tool for cardiac imaging with a growing list of clinical indications [1].
The detection of coronary disease in the investigation of atypical chest pain patients at low and intermediate risk with non-contributory functional tests is one of the main indications.
CCTA is also useful for acute chest pain patients at low risk with normal electrocardiogram (ECG) and enzymatic cycle (Fig.1).
Cardiac CT has also gradually positioned as an aid to coronary angiography or angioplasty before revascularization and also to assess the graft patency before a repeat surgery (Fig.2) [2-4].
Cardiac CT associated with an angiogram allows a better identification of aorto-ostial plaques morphology and ideal stent position in aorto-ostial coronary stenosis before angioplasty [3].
Moreover,
cardiac CT is a new tool to guide trans catheter aortic valve implantation (TAVI) [5].
In the former stage,
cardiac CT used to deliver a quite high dose of radiations to the patient [6] and its increasing use has raised concerns about exposure of patients,
particularly regarding the potential risks of long time radiation-induced cancers.
Adaptation of the CT scanner settings (high voltage and current) to the body mass index (BMI) of the patient has demonstrated its efficiency to obtain a diagnostic image quality while keeping the radiation exposure of patients As Low As Reasonably Achievable,
according to the ALARA principle [7-9].
All manufacturers have recently developed prospective ECG-gating that also represents an efficient dose reduction technique [10-12].
Iterative reconstruction algorithms are also part of the dose reduction tools in CT scanning.
Although these techniques should be implemented in the routine local protocols,
according to the local requirements in terms of image quality,
it is still rightful to wonder about patient doses for cardiac CT,
in a context of a lack of national and international dose reference level (DRL).
The objective of this study was to compare patient dose in CCTA for different CT scanners,
using different dose reduction techniques.