Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques

Gilbert L. Raff, Kavitha M. Chinnaiyan, David A. Share, Tauqir Y. Goraya, Ella A. Kazerooni, Mauro Moscucci, Ralph E. Gentry, Aiden Abidov

Research output: Contribution to journalArticle

195 Citations (Scopus)

Abstract

Context: Cardiac computed tomography angiography (CCTA) can accurately diagnose coronary artery disease, but radiation dose from this procedure is of concern. Objectives: To determine whether a collaborative radiation dose-reduction program would be associated with reduced radiation dose in patients undergoing CCTA in a statewide registry over a 1-year period and to define its effect on image quality. Design, Setting, and Patients: A prospective, controlled, nonrandomized study conducted during a control period (July-August 2007), an intervention period (September 2007-April 2008), and a follow-up period (May-June 2008) at 15 hospital imaging centers participating in the Advanced Cardiovascular Imaging Consortium in Michigan, which included small community hospitals and large academic medical centers. A total of 4995 sequential patients undergoing CCTA for suspected coronary artery disease were enrolled; 4862 patients (97.3%) had complete radiation data for analysis. Intervention: A best-practice CCTA scan model was used, which included minimized scan range, heart rate reduction, electrocardiographic-gated tube current modulation, and reduced tube voltage in suitable patients. Main Outcome Measures: Primary outcomes included dose-length product and effective radiation dose from all phases of the CCTA scan. Secondary outcomes were image quality assessed by a 4-point scale (1 indicated excellent; 2, good; 3, adequate; and 4, nondiagnostic) and frequency of diagnostic-quality scans. Results: Compared with the control period, patients' estimated median radiation dose in the follow-up period was reduced by 53.3% (dose-length product decreased from 1493 mGy x cm [interquartile range {IQR}, 855-1823 mGy x cm] to 697 mGy x cm [IQR, 407-1163 mGy x cm]; P<.001) and effective dose from 21 mSv (IQR, 12-26 mSv) to 10 mSv (IQR, 6-16 mSv) (P<.001). The greatest reduction in dose occurred at low-volume sites. There were no significant changes in median image quality assessment during the control period compared with the follow-up period (median image quality of 2 [images rated as good] vs median image quality of 2; P=.13) or frequency of diagnostic-quality scans (554/620 patients [89%] vs 769/835 patients [92%]; P=.07). Conclusion: Consistent application of currently available dose-reduction techniques was associated with a marked reduction in estimated radiation doses in a statewide CCTA registry, without impairment of image quality. Trial Registration: clinicaltrials.gov Identifier: NCT00640068

Original languageEnglish (US)
Pages (from-to)2340-2348
Number of pages9
JournalJournal of the American Medical Association
Volume301
Issue number22
DOIs
StatePublished - Jun 10 2009
Externally publishedYes

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Tomography
Radiation
Registries
Coronary Artery Disease
Community Hospital
Practice Guidelines
Computed Tomography Angiography
Heart Rate
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Medicine(all)

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Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. / Raff, Gilbert L.; Chinnaiyan, Kavitha M.; Share, David A.; Goraya, Tauqir Y.; Kazerooni, Ella A.; Moscucci, Mauro; Gentry, Ralph E.; Abidov, Aiden.

In: Journal of the American Medical Association, Vol. 301, No. 22, 10.06.2009, p. 2340-2348.

Research output: Contribution to journalArticle

Raff, Gilbert L. ; Chinnaiyan, Kavitha M. ; Share, David A. ; Goraya, Tauqir Y. ; Kazerooni, Ella A. ; Moscucci, Mauro ; Gentry, Ralph E. ; Abidov, Aiden. / Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. In: Journal of the American Medical Association. 2009 ; Vol. 301, No. 22. pp. 2340-2348.
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abstract = "Context: Cardiac computed tomography angiography (CCTA) can accurately diagnose coronary artery disease, but radiation dose from this procedure is of concern. Objectives: To determine whether a collaborative radiation dose-reduction program would be associated with reduced radiation dose in patients undergoing CCTA in a statewide registry over a 1-year period and to define its effect on image quality. Design, Setting, and Patients: A prospective, controlled, nonrandomized study conducted during a control period (July-August 2007), an intervention period (September 2007-April 2008), and a follow-up period (May-June 2008) at 15 hospital imaging centers participating in the Advanced Cardiovascular Imaging Consortium in Michigan, which included small community hospitals and large academic medical centers. A total of 4995 sequential patients undergoing CCTA for suspected coronary artery disease were enrolled; 4862 patients (97.3{\%}) had complete radiation data for analysis. Intervention: A best-practice CCTA scan model was used, which included minimized scan range, heart rate reduction, electrocardiographic-gated tube current modulation, and reduced tube voltage in suitable patients. Main Outcome Measures: Primary outcomes included dose-length product and effective radiation dose from all phases of the CCTA scan. Secondary outcomes were image quality assessed by a 4-point scale (1 indicated excellent; 2, good; 3, adequate; and 4, nondiagnostic) and frequency of diagnostic-quality scans. Results: Compared with the control period, patients' estimated median radiation dose in the follow-up period was reduced by 53.3{\%} (dose-length product decreased from 1493 mGy x cm [interquartile range {IQR}, 855-1823 mGy x cm] to 697 mGy x cm [IQR, 407-1163 mGy x cm]; P<.001) and effective dose from 21 mSv (IQR, 12-26 mSv) to 10 mSv (IQR, 6-16 mSv) (P<.001). The greatest reduction in dose occurred at low-volume sites. There were no significant changes in median image quality assessment during the control period compared with the follow-up period (median image quality of 2 [images rated as good] vs median image quality of 2; P=.13) or frequency of diagnostic-quality scans (554/620 patients [89{\%}] vs 769/835 patients [92{\%}]; P=.07). Conclusion: Consistent application of currently available dose-reduction techniques was associated with a marked reduction in estimated radiation doses in a statewide CCTA registry, without impairment of image quality. Trial Registration: clinicaltrials.gov Identifier: NCT00640068",
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AU - Chinnaiyan, Kavitha M.

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AU - Goraya, Tauqir Y.

AU - Kazerooni, Ella A.

AU - Moscucci, Mauro

AU - Gentry, Ralph E.

AU - Abidov, Aiden

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N2 - Context: Cardiac computed tomography angiography (CCTA) can accurately diagnose coronary artery disease, but radiation dose from this procedure is of concern. Objectives: To determine whether a collaborative radiation dose-reduction program would be associated with reduced radiation dose in patients undergoing CCTA in a statewide registry over a 1-year period and to define its effect on image quality. Design, Setting, and Patients: A prospective, controlled, nonrandomized study conducted during a control period (July-August 2007), an intervention period (September 2007-April 2008), and a follow-up period (May-June 2008) at 15 hospital imaging centers participating in the Advanced Cardiovascular Imaging Consortium in Michigan, which included small community hospitals and large academic medical centers. A total of 4995 sequential patients undergoing CCTA for suspected coronary artery disease were enrolled; 4862 patients (97.3%) had complete radiation data for analysis. Intervention: A best-practice CCTA scan model was used, which included minimized scan range, heart rate reduction, electrocardiographic-gated tube current modulation, and reduced tube voltage in suitable patients. Main Outcome Measures: Primary outcomes included dose-length product and effective radiation dose from all phases of the CCTA scan. Secondary outcomes were image quality assessed by a 4-point scale (1 indicated excellent; 2, good; 3, adequate; and 4, nondiagnostic) and frequency of diagnostic-quality scans. Results: Compared with the control period, patients' estimated median radiation dose in the follow-up period was reduced by 53.3% (dose-length product decreased from 1493 mGy x cm [interquartile range {IQR}, 855-1823 mGy x cm] to 697 mGy x cm [IQR, 407-1163 mGy x cm]; P<.001) and effective dose from 21 mSv (IQR, 12-26 mSv) to 10 mSv (IQR, 6-16 mSv) (P<.001). The greatest reduction in dose occurred at low-volume sites. There were no significant changes in median image quality assessment during the control period compared with the follow-up period (median image quality of 2 [images rated as good] vs median image quality of 2; P=.13) or frequency of diagnostic-quality scans (554/620 patients [89%] vs 769/835 patients [92%]; P=.07). Conclusion: Consistent application of currently available dose-reduction techniques was associated with a marked reduction in estimated radiation doses in a statewide CCTA registry, without impairment of image quality. Trial Registration: clinicaltrials.gov Identifier: NCT00640068

AB - Context: Cardiac computed tomography angiography (CCTA) can accurately diagnose coronary artery disease, but radiation dose from this procedure is of concern. Objectives: To determine whether a collaborative radiation dose-reduction program would be associated with reduced radiation dose in patients undergoing CCTA in a statewide registry over a 1-year period and to define its effect on image quality. Design, Setting, and Patients: A prospective, controlled, nonrandomized study conducted during a control period (July-August 2007), an intervention period (September 2007-April 2008), and a follow-up period (May-June 2008) at 15 hospital imaging centers participating in the Advanced Cardiovascular Imaging Consortium in Michigan, which included small community hospitals and large academic medical centers. A total of 4995 sequential patients undergoing CCTA for suspected coronary artery disease were enrolled; 4862 patients (97.3%) had complete radiation data for analysis. Intervention: A best-practice CCTA scan model was used, which included minimized scan range, heart rate reduction, electrocardiographic-gated tube current modulation, and reduced tube voltage in suitable patients. Main Outcome Measures: Primary outcomes included dose-length product and effective radiation dose from all phases of the CCTA scan. Secondary outcomes were image quality assessed by a 4-point scale (1 indicated excellent; 2, good; 3, adequate; and 4, nondiagnostic) and frequency of diagnostic-quality scans. Results: Compared with the control period, patients' estimated median radiation dose in the follow-up period was reduced by 53.3% (dose-length product decreased from 1493 mGy x cm [interquartile range {IQR}, 855-1823 mGy x cm] to 697 mGy x cm [IQR, 407-1163 mGy x cm]; P<.001) and effective dose from 21 mSv (IQR, 12-26 mSv) to 10 mSv (IQR, 6-16 mSv) (P<.001). The greatest reduction in dose occurred at low-volume sites. There were no significant changes in median image quality assessment during the control period compared with the follow-up period (median image quality of 2 [images rated as good] vs median image quality of 2; P=.13) or frequency of diagnostic-quality scans (554/620 patients [89%] vs 769/835 patients [92%]; P=.07). Conclusion: Consistent application of currently available dose-reduction techniques was associated with a marked reduction in estimated radiation doses in a statewide CCTA registry, without impairment of image quality. Trial Registration: clinicaltrials.gov Identifier: NCT00640068

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