Author + information
- Received December 6, 2018
- Revision received March 1, 2019
- Accepted March 16, 2019
- Published online June 12, 2019.
- Thomas J. Stocker, MDa,b,∗∗ (, )
- Jonathon Leipsic, MDc,
- Martin Hadamitzky, MDd,
- Marcus Y. Chen, MDe,
- Ronen Rubinshtein, MDf,
- Simon Deseive, MDa,b,
- Mathias Hecknera,
- Jeroen J. Bax, MD, PhDg,
- Kakuya Kitagawa, MD, PhDh,
- Hugo Marques, MDi,
- Axel Schmermund, MDj,
- Claudio Silva, MDk,
- John Mahmarian, MDl,
- Joon-Won Kang, MD, PhDm,
- Erik L. Grove, MD, PhDn,o,
- John Lesser, MDp,
- Steffen Massberg, MDa,b and
- Jörg Hausleiter, MDa,b,∗ ()
- aMedizinische Klinik und Poliklinik I, Ludwig Maximilians-Universität, Munich, GermanyMedizinische Klinik und Poliklinik I, Ludwig Maximilians-Universitat, Munich, Germany
- bDZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, GermanyDZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- cUniversity of British Columbia, Vancouver, CanadaUniversity of British Columbia, Vancouver, Canada
- dInstitut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Munich, GermanyInstitut fur Radiologie und Nuklearmedizin, Deutsches Herzzentrum Munchen, Munich, Germany
- eNational Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MarylandNational Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
- fLady Davis Carmel Medical Center, Haifa, IsraelLady Davis Carmel Medical Center, Haifa, Israel
- gDepartment of Cardiology, Leiden University Medical Center, Leiden, the NetherlandsDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- hMie University Hospital, Tsu, JapanhMie University Hospital, Tsu, Japan
- iUNICA (Cardiovascular imaging Unit), Hospital da Luz, Lisbon, PortugalUNICA (Cardiovascular imaging Unit), Hospital da Luz, Lisbon, Portugal
- jCardioangiologisches Centrum Bethanien, CCB, Frankfurt, GermanyCardioangiologisches Centrum Bethanien, CCB, Frankfurt, Germany
- kRadiology Department, Clinica Alemana de Santiago, Santiago, ChileRadiology Department, Clinica Alemana de Santiago, Santiago, Chile
- lHouston Methodist Hospital, Houston, TexasHouston Methodist Hospital, Houston, Texas
- mAsan Medical Center, Seoul, South KoreamAsan Medical Center, Seoul, South Korea
- nAarhus University Hospital, Aarhus, DenmarknAarhus University Hospital, Aarhus, Denmark
- oDepartment of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, DenmarkDepartment of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
- pMinneapolis Heart Institute, Minneapolis, MinnesotaMinneapolis Heart Institute, Minneapolis, Minnesota
- ↵∗Address for correspondence:
Dr. Jörg Hausleiter, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistrasse 15, 81377 Munich, Germany.
- ↵∗∗Dr. Thomas J. Stocker, Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig-Maximilians-Universität, Marchioninistrasse 15, 81377 Munich, Germany.
Objectives The aim of this study was to assess the use of low tube potentials for coronary computed tomography angiography (CCTA) in worldwide clinical practice and its influence on radiation exposure, contrast agent volume, and image quality.
Background CCTA is frequently used in clinical practice. Lowering of tube potential is a potent method to reduce radiation exposure and to economize contrast agent volume.
Methods CCTAs of 4,006 patients from 61 international study sites were analyzed regarding very-low (≤80 kVp), low (90 to 100 kVp), conventional (110 to 120 kVp), and high (≥130 kVp) tube potentials. The impact on dose-length product (DLP) and contrast agent volume was analyzed. Image quality was determined by evaluation of the diagnostic applicability and assessment of the objective image parameters signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR).
Results When compared with conventional tube potentials, low tube potentials were used in 56% of CCTAs (≤80 kVp: 9%; 90 to 100 kVp: 47%), which varied among sites from 0% to 100%. Tube potential reduction was associated with low–cardiovascular risk profile, low body mass index (BMI), and new-generation scanners. Median radiation exposure was lowered by 68% or 50% and median contrast agent volume by 25% or 13% for tube potential protocols of ≤80 kVp or 90 to 100 kVp when compared with conventional tube potentials, respectively (all p < 0.001). With the use of lower tube potentials, the frequency of diagnostic scans was maintained (p = 0.41), whereas SNR and CNR significantly improved (both p < 0.001). Considering BMI eligibility criteria, 58% (n = 946) of conventionally scanned patients would have been suitable for low tube potential protocols, and 44% (n = 831) of patients scanned with 90 to 100 kVp would have been eligible for very-low tube potential CCTA imaging of ≤80 kVp.
Conclusions This large international registry confirms the feasibility of tube potential reduction in clinical practice leading to lower radiation exposure and lower contrast volumes. The current registry also demonstrates that this strategy is still underused in daily practice. PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 [PROTECTION-VI]; NCT02996903)
- cardiac imaging
- coronary computed tomography angiography
- dose-saving strategies
- radiation dose
- tube potential
Dr. Leipsic is a consultant to and holds stock options in Circle CVI and HeartFlow; and has received fellow support from GE Healthcare outside the submitted work. Dr. Chen has received non-financial support from Canon Medical systems outside the submitted work. Dr. Bax has received grants from Biotronik, Medtronic, Boston Scientific, GE Healthcare, and Edwards Lifesciences outside the submitted work; and has received speaker fees from Abbott Vascular. Dr. Schmermund has received grants from Siemens outside the submitted work. Dr. Grove has received speaker honoraria or consultancy fees from Abbott, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, and Roche outside the submitted work. Dr. Hausleiter has received speaker honoraria and research support from Abbott Vascular and Edwards Lifesciences outside the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 6, 2018.
- Revision received March 1, 2019.
- Accepted March 16, 2019.
- 2019 American College of Cardiology Foundation
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