The sub-millisievert era in CTCA: the technical basis of the new radiation dose approach
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CARDIAC RADIOLOGY
The sub‑millisievert era in CTCA: the technical basis of the new radiation dose approach Nicolò Schicchi1 · Marco Fogante1 · Pierpaolo Palumbo2 · Giacomo Agliata1 · Paolo Esposto Pirani1 · Ernesto Di Cesare2 · Andrea Giovagnoni1 Received: 10 August 2020 / Accepted: 3 September 2020 © Italian Society of Medical Radiology 2020
Abstract Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose reduction over the last decade was obtained, with the beginning of the sub-mSv era in CTCA. The main technical basis to obtain a radiation dose reduction in CTCA is the use of a low tube voltage, the adoption of a prospective electrocardiogram-triggering spiral protocol and the application of the tube current modulation with the iterative reconstruction technique. Nevertheless, CTCA examinations are characterized by a wide range of radiation doses between different radiology departments. Moreover, the dose exposure in CTCA is extremely important because the benefit–risk calculus in comparison with other modalities also depends on it. Finally, because anatomical evaluation not adequately predicts the hemodynamic relevance of coronary stenosis, a low radiation dose in routine CTCA would allow the greatest use of the myocardial CT perfusion, fractional flow reserve-CT, dual-energy CT and artificial intelligence, to shift focus from morphological assessment to a comprehensive morphological and functional evaluation of the stenosis. Therefore, the aim of this work is to summarize the correct use of the technical basis in order that CTCA becomes an established examination for assessment of the coronary artery disease with low radiation dose. Keywords Cardiac CT · Coronary CT · Dual-source CT · High-pitch protocol · Radiation dose · Radiation reduction
Introduction Cardiac imaging has emerged over the past two decades as one of the most important and dynamic advances in radiology, and the computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of heart disease. In particular, for patients with suspected coronary artery diseases, the CTCA has high sensitivity and negative predictive value to rule out obstructive stenosis and it allows avoiding many invasive coronary angiography [1, 2]. Therefore, the number of CTCA is rapidly increasing and cardiac imaging with interventional procedures is * Marco Fogante [email protected] 1
Radiology Department, Azienda Ospedaliero Universitaria “Ospedali Riuniti”, 60126 Ancona, Italy
Radiology Department, Azienda Ospedaliero Universitaria “San Salvatore”, 60126 L’Aquila, Italy
2
responsible for approximately 40% of the cumulative effective dose (ED) in medical imaging. Therefore, considerations about radiation dose in CTCA are an important concern, especially for the cohort of younge
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