Document Type : Original Article(s)
- Seyedeh Shokoofeh Mousavi-Gazafroudi 1
- Amirreza Sajjadieh-Khajouei 2
- Maryam Moradi 3
- Seyedeh Shabnam Mousavi-Gazafroudi 4
- Ghasem Yadegarfar 5
- Mohammad Bagher Tavakoli 6
1 Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Associate Professor, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Medical Physics, School of Medicine, Tarbiat Modares University, Tehran, Iran
5 Associate Professor, Heart Failure Research Center, Cardiovascular Research Institute AND Department of Epidemiology and Biostat, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
6 Professor, Department of Medical Physics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: Coronary computed tomography angiography (CCTA) is an important modality in diagnosis of coronary artery disease (CAD). Owing to the fact that computed tomography (CT) examinations are performed using ionizing radiation; applying radiation dose-reduction strategies seems to be necessary. Lowering tube voltage (in kV) according to the patient’s body mass index (BMI) or weight is an approach that is investigated by many researchers. The goal of this study was to evaluate the impact of low tube voltage CCTA on radiation dose and image quality in order to decrease radiation dose in selected patients who meet inclusion criteria of the introduced protocol.METHODS: Patients with clinical indications of CCTA who met inclusion criteria were classified in two groups randomly. Imaging of two groups was performed using 120 kV and 100 kV, respectively. Subjective and objective parameters of image quality and radiation dose of two groups were measured. Afterward, data were analyzed by appropriate statistical tests using SPSS software.RESULTS: While differences in image quality between two groups were not significant, radiation dose of patients who underwent 100 kV CCTA was significantly lower than the other group. Effective doses (EDs) of first and second groups were 22.30 ± 5.48 mSv and 13.82 ± 2.00 mSv, respectively (P < 0.001).CONCLUSION: Lowering tube voltage in non-obese patients is an effective and practical approach to radiation dose reduction without missing image quality that should be considered especially for female patients.
- Sajjadieh A, Hekmatnia A, Keivani M, Asoodeh A, Pourmoghaddas M, Sanei H. Diagnostic performance of 64-row coronary CT angiography in detecting significant stenosis as compared with conventional invasive coronary angiography. ARYA Atheroscler 2013; 9(2): 157-63.
- Shah A, Das P, Subkovas E, Buch AN, Rees M, Bellamy C. Radiation dose during coronary angiogram: Relation to body mass index. Heart Lung Circ 2015; 24(1): 21-5.
- Kayan M, Koroglu M, Yesildag A, Ceylan E, Aktas AR, Yasar S, et al. Carotid CT-angiography: Low versus standard volume contrast media and low kV protocol for 128-slice MDCT. Eur J Radiol 2012; 81(9): 2144-7.
- Shapiro BP, Young PM, Kantor B, Choe YH, McCollough CH, Gerber TC. Radiation dose reduction in CT coronary angiography. Curr Cardiol Rep 2010; 12(1): 59-67.
- Xu L, Zhang Z. Coronary CT angiography with low radiation dose. Int J Cardiovasc Imaging 2010; 26(Suppl 1): 17-25.
- Raff GL. Radiation dose from coronary CT angiography: Five years of progress. J Cardiovasc Comput Tomogr 2010; 4(6): 365-74.
- Wintersperger B, Jakobs T, Herzog P, Schaller S, Nikolaou K, Suess C, et al. Aorto-iliac multidetector-row CT angiography with low kV settings: Improved vessel enhancement and simultaneous reduction of radiation dose. Eur Radiol 2005; 15(2): 334-41.
- Achenbach S, Marwan M, Ropers D, Schepis T, Pflederer T, Anders K, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J 2010; 31(3): 340-6.
- Achenbach S, Marwan M, Schepis T, Pflederer T, Bruder H, Allmendinger T, et al. High-pitch spiral acquisition: A new scan mode for coronary CT angiography. J Cardiovasc Comput Tomogr 2009; 3(2): 117-21.
- Sabarudin A, Sun Z. Coronary CT angiography: Dose reduction strategies. World J Cardiol 2013; 5(12): 465-72.
- Sigal-Cinqualbre AB, Hennequin R, Abada HT, Chen X, Paul JF. Low-kilovoltage multi-detector row chest CT in adults: Feasibility and effect on image quality and iodine dose. Radiology 2004; 231(1): 169-74.
- Einstein AJ, Moser KW, Thompson RC, Cerqueira MD, Henzlova MJ. Radiation dose to patients from cardiac diagnostic imaging. Circulation 2007; 116(11): 1290-305.
- Shen Y, Sun Z, Xu L, Li Y, Zhang N, Yan Z, et al. High-pitch, low-voltage and low-iodine-concentration CT angiography of aorta: Assessment of image quality and radiation dose with iterative reconstruction. PLoS One 2015; 10(2): e0117469.
- Meinel FG, Canstein C, Schoepf UJ, Sedlmaier M, Schmidt B, Harris BS, et al. Image quality and radiation dose of low tube voltage 3rd generation dual-source coronary CT angiography in obese patients: A phantom study. Eur Radiol 2014; 24(7): 1643-50.
- Meyer M, Haubenreisser H, Schoepf UJ, Vliegenthart R, Leidecker C, Allmendinger T, et al. Closing in on the K edge: Coronary CT angiography at 100, 80, and 70 kV-initial comparison of a second- versus a third-generation dual-source CT system. Radiology 2014; 273(2): 373-82.
- Leschka S, Stolzmann P, Schmid FT, Scheffel H, Stinn B, Marincek B, et al. Low kilovoltage cardiac dual-source CT: Attenuation, noise, and radiation dose. Eur Radiol 2008; 18(9): 1809-17.
- Blankstein R, Bolen MA, Pale R, Murphy MK, Shah AB, Bezerra HG, et al. Use of 100 kV versus 120 kV in cardiac dual source computed tomography: Effect on radiation dose and image quality. Int J Cardiovasc Imaging 2011; 27(4): 579-86.
- Cody DD, Moxley DM, Krugh KT, O'Daniel JC, Wagner LK, Eftekhari F. Strategies for formulating appropriate MDCT techniques when imaging the chest, abdomen, and pelvis in pediatric patients. AJR Am J Roentgenol 2004; 182(4): 849-59.
- Zhang C, Zhang Z, Yan Z, Xu L, Yu W, Wang R. 320-row CT coronary angiography: Effect of 100-kV tube voltages on image quality, contrast volume, and radiation dose. Int J Cardiovasc Imaging 2011; 27(7): 1059-68.
- Pflederer T, Rudofsky L, Ropers D, Bachmann S, Marwan M, Daniel WG, et al. Image quality in a low radiation exposure protocol for retrospectively ECG-gated coronary CT angiography. AJR Am J Roentgenol 2009; 192(4): 1045-50.
- Mangold S, Wichmann JL, Schoepf UJ, Litwin SE, Canstein C, Varga-Szemes A, et al. Coronary CT angiography in obese patients using 3(rd) generation dual-source CT: Effect of body mass index on image quality. Eur Radiol 2016; 26(9): 2937-46.
- Lee JW, Kim CW, Lee HC, Wu MT, Hwangbo L, Choo KS, et al. High-definition computed tomography for coronary artery stents: Image quality and radiation doses for low voltage (100 kVp) and standard voltage (120 kVp) ECG-triggered scanning. Int J Cardiovasc Imaging 2015; 31(Suppl 1): 39-49.
- Zheng M, Wu Y, Wei M, Liu Y, Zhao H, Li J. Low-concentration contrast medium for 128-slice dual-source CT coronary angiography at a very low radiation dose using prospectively ECG-triggered high-pitch spiral acquisition. Acad Radiol 2015; 22(2): 195-202.
- Yang L, Xu L, Yan Z, Yu W, Fan Z, Lv B, et al. Low dose 320-row CT for left atrium and pulmonary veins imaging-the feasibility study. Eur J Radiol 2012; 81(7): 1549-54.
- Khan AN, Khosa F, Shuaib W, Nasir K, Blankstein R, Clouse M. Effect of Tube Voltage (100 vs. 120 kVp) on Radiation Dose and Image Quality using Prospective Gating 320 Row Multi-detector Computed Tomography Angiography. J Clin Imaging Sci 2013; 3: 62.
- Marwan M, Mettin C, Pflederer T, Seltmann M, Schuhback A, Muschiol G, et al. Very low-dose coronary artery calcium scanning with high-pitch spiral acquisition mode: Comparison between 120-kV and 100-kV tube voltage protocols. J Cardiovasc Comput Tomogr 2013; 7(1): 32-8.
- Ripsweden J, Brismar TB, Holm J, Melinder A, Mir-Akbari H, Nilsson T, et al. Impact on image quality and radiation exposure in coronary CT angiography: 100 kVp versus 120 kVp. Acta Radiol 2010; 51(8): 903-9.
- Bischoff B, Hein F, Meyer T, Hadamitzky M, Martinoff S, Schomig A, et al. Impact of a reduced tube voltage on CT angiography and radiation dose: Results of the PROTECTION I study. JACC Cardiovasc Imaging 2009; 2(8): 940-6.
- Kidoh M, Nakaura T, Nakamura S, Nakamura S, Sakaino N, Harada K, et al. Low-contrast-dose protocol in cardiac CT: 20% contrast dose reduction using 100 kVp and high-tube-current-time setting in 256-slice CT. Acta Radiol 2014; 55(5): 545-53.
- Feuchtner GM, Jodocy D, Klauser A, Haberfellner B, Aglan I, Spoeck A, et al. Radiation dose reduction by using 100-kV tube voltage in cardiac 64-slice computed tomography: A comparative study. Eur J Radiol 2010; 75(1): e51-e56.