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Randomized Controlled Trial
. 2014 Dec;55(10):1186-96.
doi: 10.1177/0284185113514886. Epub 2013 Dec 5.

Contrast material and radiation dose reduction strategy for triple-rule-out cardiac CT angiography: feasibility study of non-ECG-gated low kVp scan of the whole chest following coronary CT angiography

Masafumi Kidoh  1 , Takeshi Nakaura  2 , Shinichi Nakamura  2 , Tomohiro Namimoto  3 , Toshimitsu Nozaki  4 , Naritsugu Sakaino  4 , Kazunori Harada  5 , Yasuyuki Yamashita  3
Affiliations
Randomized Controlled Trial

Contrast material and radiation dose reduction strategy for triple-rule-out cardiac CT angiography: feasibility study of non-ECG-gated low kVp scan of the whole chest following coronary CT angiography

Masafumi Kidoh et al. Acta Radiol. 2014 Dec.

Abstract

Background: Dedicated coronary computed tomography (CT) scan has been proven to be an accurate diagnostic modality in evaluating coronary artery disease. A second phase scan starting immediately after the coronary CT scan might enable visualization of the different vascular territories of the entire chest.

Purpose: To investigate the feasibility of a contrast material and radiation dose reduction triple-rule-out (TRO) CT angiography (CTA) protocol with serial non-ECG-gated low kVp scan of the whole chest, which utilizes a recirculated contrast agent.

Material and methods: Thirty patients were scanned with the new TRO-CTA protocol; after the coronary scan with retrospective ECG-gating, non-ECG-gated whole-chest CTA was performed at 80 kVp to evaluate aortic arch (AAr) and pulmonary trunk (PT). Another 30 patients were scanned by our conventional TRO-CTA protocol at 120 kVp with retrospective ECG-gating. We compared the estimated effective dose (ED), contrast material (CM) dose, contrast-to-noise ratio (CNR) of the ascending aorta (AAo), and the rate of patients who could achieve adequate attenuation of the AAr and PT between the two protocols.

Results: The total ED of the new TRO-CTA protocol was 29.6% lower than that of the conventional protocol (P < 0.01). The amount of CM used for the new TRO-CTA protocol was significantly lower than in the conventional protocol (60.1 ± 9.6 mL vs. 91.8 ± 22.6 mL, P < 0.01). The CNR of the AAo was 30.2% higher with the new TRO-CTA protocol than with the conventional protocol (P < 0.01). There was no significant difference in the success rate of adequate attenuation of the AAr and PT between the two protocols (P > 0.05).

Conclusion: The new TRO-CTA protocol can reduce the total dose of radiation and the contrast dose and yield adequate vascular enhancement compared with the conventional protocol.

Keywords: Triple-rule-out CT angiography; contrast dose; low tube voltage; radiation dose.

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