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Radiation reduction with prospective ECG-triggering acquisition using 64-multidetector computed tomographic angiography

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Abstract

Current 64-multidetector Computed Tomographic scanners (MDCT) utilize retrospective overlapping helical acquisition (RS-OHA) which imparts a higher than desired radiation dose. Although the radiation burden of computed tomographic angiography (CTA) can be efficiently reduced by dose modulation and limiting field of view, a further decrease in radiation without compromising diagnostic image quality would be indeed very desirable. An alternative imaging mode is the axial prospective ECG-triggering acquisition (prospective gating). This study was done to compare the effective radiation dose and the image quality with two techniques to reduce radiation doses with CTA studies utilizing 64-MDCT scanners. The study included 149 consecutive patients (48 females and 101 males) 64-MDCT (mean age = 67 ± 11 years, 72.2% male). Patients underwent CT coronary angiography using one of three algorithms: retrospective triggering with dose modulation; prospective triggering with padding (step and shoot acquisition with additional adjacent phases); and prospective triggering without padding (single phase acquisition only). Based on body habitus, two different voltages were utilized: 100 kVp (<85 kg) or 120 kVp (>85 kg). Radiation doses and image quality (signal to noise ratio) was measured for each patient, and compared between different acquisition protocols. The signal to-noise ratio of the ascending aorta (SNR-AA) was calculated from the mean pixel values of the contrast-filled left ventricular chamber divided by the standard deviation of these pixel values. Use of 100 kVp reduced radiation dose 41.5% using prospective triggering and 39.6% using retrospective imaging as compared to 120 kVp (P < 0.001). Use of prospective imaging reduced radiation exposure by 82.6% as compared to retrospective imaging (P < 0.001). Using both prospective imaging and 100 kVp without padding (single phase data, no other phases obtained), radiation dose was reduced by 90% (P < 0.001). In terms of image quality, the coefficient of variation of ascending aortic contrast enhancement between kVp of 120 and kVp of 100 was 6% (1.05, 95 CI 0.93–1.17), and 7.8% (0.9, 95% CI 0.7–1.2) at the pulmonary artery. The prospective ECG-Triggered acquisition and 100 kVp images were of diagnostic quality, allowing adequate assessment in all patients. CTA using PA and 100 kVp reduced the radiation dose by up to 90% without compromising the image quality.

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Authors and Affiliations

  1. Los Angeles Biomedical Research Institute at Harbor-UCLA, 1124 W. Carson Street, RB2, Torrance, CA, 90502, USA

    Ambarish Gopal, Song S. Mao, Daniel Karlsberg, Emily Young, Joshua Waggoner, Naser Ahmadi, Raveen S. Pal, John Leal, Ronald P. Karlsberg & Matthew J. Budoff

  2. Cardiovascular Medical Group, Beverly Hills, CA, USA

    Ambarish Gopal, Song S. Mao, Daniel Karlsberg, Emily Young, Joshua Waggoner, Naser Ahmadi, Raveen S. Pal, John Leal, Ronald P. Karlsberg & Matthew J. Budoff

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  1. Ambarish Gopal
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  2. Song S. Mao
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  4. Emily Young
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Correspondence to Matthew J. Budoff.

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Gopal, A., Mao, S.S., Karlsberg, D. et al. Radiation reduction with prospective ECG-triggering acquisition using 64-multidetector computed tomographic angiography. Int J Cardiovasc Imaging 25, 405–416 (2009). https://doi.org/10.1007/s10554-008-9396-z

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  • DOI: https://doi.org/10.1007/s10554-008-9396-z

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