Individualized coronary calcium scoring at any tube voltage using a kV-independent reconstruction algorithm
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COMPUTED TOMOGRAPHY
Individualized coronary calcium scoring at any tube voltage using a kV-independent reconstruction algorithm Vincenzo Vingiani 1,2,3 & Andres F. Abadia 1 & U. Joseph Schoepf 1 & Andreas M. Fischer 1 & Akos Varga-Szemes 1 & Pooyan Sahbaee 4,5 & Thomas Allmendinger 4 & Dante A. Giovagnoli 1 & H. Todd Hudson 1 & Riccardo Marano 2,3 & Fiona C. Tinnefeld 1 & Simon S. Martin 1,6 Received: 3 March 2020 / Accepted: 11 May 2020 # European Society of Radiology 2020
Abstract Purpose We prospectively investigate the feasibility of a patient specific automated tube voltage selection (ATVS)-based coronary artery calcium scoring (CACS) protocol, using a kV-independent reconstruction algorithm, to achieve significant dose reductions while maintaining the overall cardiac risk classification. Methods Forty-three patients (mean age, 61.8 ± 9.0 years; 40% male) underwent a clinically indicated CACS scan at 120kVp, as well as an additional CACS acquisition using an individualized tube voltage between 70 and 130kVp based on the ATVS selection (CARE-kV). Datasets of the additional CACS scans were reconstructed using a kV-independent algorithm that allows for calcium scoring without changing the weighting threshold of 130HU, regardless of the tube voltage chosen for image acquisition. Agatston scores and radiation dose derived from the different ATVS-based CACS studies were compared to the standard acquisition at 120kVp. Results Thirteen patients displayed a score of 0 and were correctly identified with the ATVS protocol. Agatston scores derived from the standard 120kVp (median, 33.4; IQR, 0–289.7) and the patient-tailored kV-independent protocol (median, 47.5; IQR, 0–287.5) showed no significant differences (p = 0.094). The intra-class correlation for Agatston scores derived from the two different protocols was excellent (ICC = 0.99). The mean dose-length-product was 29.8 ± 11.9 mGy × cm using the ATVS protocol and 31.7 ± 11.4 mGy × cm using the standard 120kVp protocol (p < 0.001). Additionally, 95% of patients were classified into the same risk category (0, 1–10, 11–100, 101–400, or > 400) using the patient-tailored protocol. Conclusions ATVS-based CACS, using a kV-independent algorithm, allows for high accuracy compared to the standard 120kVp scanning, while significantly reducing radiation dose parameters. Key Points • ATVS allows for CT scanning with reduced radiation dose values. • KV-independent CACS is feasible at any tube voltage between 70 and 130 kVp. • ATVS applied to kV-independent CACS can significantly reduce the radiation dose. Keywords Multidetector computed tomography . Coronary artery disease . Image processing, computer-assisted . Risk factors . Radiation dosage
* U. Joseph Schoepf [email protected]
3
Università Cattolica del Sacro Cuore, Rome, Italy
4
Computed Tomography – Research & Development, Siemens Healthcare GmbH, Forchheim, Germany
1
5
Siemens Medical Solutions USA, Malvern, PA, USA
6
Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt,
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