PMID- 30927938
OWN - NLM
STAT- MEDLINE
DCOM- 20190528
LR  - 20190528
IS  - 1872-7727 (Electronic)
IS  - 0720-048X (Linking)
VI  - 113
DP  - 2019 Apr
TI  - Coronary CT angiography radiation dose trends: A 10-year analysis to develop 
      institutional diagnostic reference levels.
PG  - 140-147
LID - S0720-048X(19)30063-4 [pii]
LID - 10.1016/j.ejrad.2019.02.012 [doi]
AB  - PURPOSE: To develop institutional diagnostic reference levels (IDRL) for coronary 
      CT angiography (CCTA) according to patient size by analyzing radiation dose 
      changes over the past 10 years. MATERIALS AND METHODS: This IRB approved 
      retrospective investigation analyzed radiation dose data from CCTA between 2007 
      and 2016 at our institution. Annual trends in radiation dose were described for 
      each scanner type and scanning mode. Radiation levels were analyzed for 
      normorhythmic patients, patients with prior coronary artery bypass grafting 
      (CABG), arrhythmia, and according to patient size and tube voltage. Median, and 
      quartile values for volume CT dose index (CTDIvol), dose-length product (DLP), 
      and size-specific dose estimate (SSDE) were calculated. Wilcoxon rank-sum test 
      and Kruskal Wallis test were performed to assess the significance of quantitative 
      data. RESULTS: 35,375 examinations from 33,317 patients (median age, 58 [50-66] 
      years; male patients, 21,087 [58.7%]) were analyzed. CTDIvol, DLP, and SSDE 
      significantly decreased by 9.0%, 30.8%, and 40.1% (all P < 0.05) for all 
      examinations, respectively. All radiation dose metrics progressively decreased 
      across scanning modes (especially retrospectively ECG-gated spiral and 
      prospectively ECG-triggered high-pitch spiral acquisition mode), but did not 
      significantly change across scanners in the last 6 years. CTDIvol and DLP 
      increased with patient size when water-equivalent diameters were >19 cm for 
      normorhythmic and CABG patients. In arrhythmic patients, CTDIvol increased 
      progressively with water-equivalent diameters across all groups. CONCLUSION: CCTA 
      radiation dose has progressively decreased in the past decade except in patients 
      with prior CABG and arrhythmia. Size-specific IDRLs may optimize radiation 
      utilization in these patients going forward.
CI  - Copyright (c) 2019 Elsevier B.V. All rights reserved.
FAU - Lin, Zhu Xiao
AU  - Lin ZX
AD  - Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing 
      University, Nanjing, Jiangsu 210002, China.
FAU - Zhou, Chang Sheng
AU  - Zhou CS
AD  - Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing 
      University, Nanjing, Jiangsu 210002, China.
FAU - Schoepf, U Joseph
AU  - Schoepf UJ
AD  - Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing 
      University, Nanjing, Jiangsu 210002, China; Division of Cardiovascular Imaging, 
      Department of Radiology and Radiological Science, Medical University of South 
      Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC 29425, 
      United States.
FAU - Eid, Marwen
AU  - Eid M
AD  - Division of Cardiovascular Imaging, Department of Radiology and Radiological 
      Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 
      Courtenay Dr, Charleston, SC 29425, United States.
FAU - Duguay, Taylor M
AU  - Duguay TM
AD  - Division of Cardiovascular Imaging, Department of Radiology and Radiological 
      Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 
      Courtenay Dr, Charleston, SC 29425, United States.
FAU - Greenberg, William T
AU  - Greenberg WT
AD  - Division of Cardiovascular Imaging, Department of Radiology and Radiological 
      Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 
      Courtenay Dr, Charleston, SC 29425, United States.
FAU - Luo, Song
AU  - Luo S
AD  - Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing 
      University, Nanjing, Jiangsu 210002, China.
FAU - Quan, Wei
AU  - Quan W
AD  - Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing 
      University, Nanjing, Jiangsu 210002, China.
FAU - Zhou, Fan
AU  - Zhou F
AD  - Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing 
      University, Nanjing, Jiangsu 210002, China.
FAU - Lu, Guang Ming
AU  - Lu GM
AD  - Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing 
      University, Nanjing, Jiangsu 210002, China. Electronic address: 
      cjr.luguangming@vip.163.com.
FAU - Zhang, Long Jiang
AU  - Zhang LJ
AD  - Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing 
      University, Nanjing, Jiangsu 210002, China. Electronic address: 
      kevinzhlj@163.com.
LA  - eng
PT  - Journal Article
PT  - Observational Study
DEP - 20190213
PL  - Ireland
TA  - Eur J Radiol
JT  - European journal of radiology
JID - 8106411
SB  - IM
MH  - Aged
MH  - Arrhythmias, Cardiac/diagnostic imaging
MH  - Computed Tomography Angiography/standards/*trends
MH  - Cone-Beam Computed Tomography/standards/trends
MH  - Coronary Angiography/standards/*trends
MH  - Coronary Artery Bypass/statistics & numerical data
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Radiation Dosage
MH  - Reference Values
MH  - Retrospective Studies
MH  - Statistics, Nonparametric
OTO - NOTNLM
OT  - Coronary CT angiography
OT  - Diagnostic reference levels
OT  - Radiation dose
EDAT- 2019/04/01 06:00
MHDA- 2019/05/29 06:00
CRDT- 2019/04/01 06:00
PHST- 2018/10/04 00:00 [received]
PHST- 2018/12/31 00:00 [revised]
PHST- 2019/02/12 00:00 [accepted]
PHST- 2019/04/01 06:00 [entrez]
PHST- 2019/04/01 06:00 [pubmed]
PHST- 2019/05/29 06:00 [medline]
AID - S0720-048X(19)30063-4 [pii]
AID - 10.1016/j.ejrad.2019.02.012 [doi]
PST - ppublish
SO  - Eur J Radiol. 2019 Apr;113:140-147. doi: 10.1016/j.ejrad.2019.02.012. Epub 2019 
      Feb 13.