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. 2021 Sep 24;8(10):119.
doi: 10.3390/jcdd8100119.

Radiation Dose and Image Quality of a High-Pitch Prospective Spiral First Approach in Coronary Computed Tomography Angiography (CCTA)

Tom Finck  1 , Konstantin Klambauer  1 , Eva Hendrich  1 , Albrecht Will  1 , Stefan Martinoff  1 , Martin Hadamitzky  1
Affiliations

Radiation Dose and Image Quality of a High-Pitch Prospective Spiral First Approach in Coronary Computed Tomography Angiography (CCTA)

Tom Finck et al. J Cardiovasc Dev Dis. .

Abstract

Objective: To investigate a high-pitch spiral first (HPSF) approach for coronary computed tomography angiography (CCTA) in an unselected patient cohort and compare diagnostic yield and radiation exposure to CCTAs acquired via conventional, non-high-pitch spiral first (NHPSF) scan regimes. Materials and Methods: All consecutive patients from 1 January 2015 to 31 December 2017 were included. Two investigation protocols (HPSF/NHPSF) were used with the aim to achieve diagnostic image quality of all coronary segments. Low-pitch secondary scans followed the initial examination if image quality was unsatisfactory. Dosage and image quality were compared between both regimes. Results: 1410 patients were subject to a HPSF and 236 patients to a NHPSF approach. While the HPSF approach led to a higher fraction of re-scans (35% vs. 11%, p < 0.001), the fraction of aggregate scans that remained non-diagnostic after considering the initial and secondary scan was comparably low for the HPSF and NHPSF approach (0.78 vs. 0%, p = 0.18). Aggregate radiation exposure in the HPSF protocol was significantly lower (1.12 mSv (IQR: 0.73, 2.10) vs. 3.96 mSv (IQR: 2.23, 8.33) p < 0.001). Conclusions: In spite of a higher number of re-scans, a HPSF approach leads to a reduction in overall radiation exposure with diagnostic yields similar to a NHPSF approach.

Keywords: coronary artery disease; coronary computed tomography angiography; high-pitch-spiral scan; radiation exposure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Rating score for the image quality of coronary arteries using curved planar reformations. From left to right: grade 2—excellent (good interpretability in all coronary segments); grade 1—diagnostic (reduced interpretability of at least one coronary segment); grade 0—non-diagnostic (at least one coronary segment is not interpretable).
Figure 2
Figure 2
Flow chart of image acquisition. RS: retrospective spiral, SAS: prospective step-and-shoot, HPS: high-pitch spiral; HPSF: high-pitch spiral first; NHPSF: non-high-pitch spiral first; IQ: image quality; CAD: coronary artery disease.
Figure 3
Figure 3
The image quality of the first scan as well as the aggregate of the first and potential second CCTA for patients with the HPSF and NHPSF protocol. HPSF: high-pitch spiral first; NHPSF: non-high-pitch spiral first.
Figure 4
Figure 4
Image quality of the first and repeat scans for patients with a HPSF and NHPSF approach. HPSF: high-pitch spiral first; NHPSF: non-high-pitch spiral first.
Figure 5
Figure 5
The scan quality of the first scan for patients investigated with the HPSF or NHPFS protocol after dichotomization for heart rate or cardiac rhythm. HPSF: high-pitch spiral first; NHPSF: non high pitch spiral first; SR: sinus rhythm without extrasystoles; ES: extrasystoles; bpm: beats per minute.
Figure 6
Figure 6
Radiation exposure (median, interquartile-range) for patients investigated with a HPSF and NHPSF approach. HPSF: high-pitch spiral first; NHPSF: non high pitch spiral first. All results are significant with a p-value < 0.001.
Figure 7
Figure 7
Radiation exposure (median, interquartile-range) for patients investigated with a HPSF and NHPSF approach after dichotomization for heart rate and extrasystoles. HPSF: high-pitch spiral first; NHPSF: non high pitch spiral first; SR: Scheme 0.
See this image and copyright information in PMC

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