Influence of Heart Rate on Image Quality and Radiation Dose Exposure in Coronary CT Angiography

HomeRadiologyVol. 300, No. 3 PreviousNext Original ResearchFree AccessResearch LetterInfluence of Heart Rate on Image Quality and Radiation Dose Exposure in Coronary CT AngiographyThomas J. Stocker, Jonathon Leipsic, Marcus Y. Chen, Stephan Achenbach, Juhani Knuuti, David Newby, Jörg Hausleiter Thomas Author AffiliationsFrom the Medizinische Klinik und Poliklinik I, Ludwig-Maximilians-Universität, Marchioninistrasse 15, Munich 81377, Germany (T.J.S., J.H.); DZHK (German Center for Cardiovascular Research), Partner Site Alliance, Munich, Department Medical Imaging Division Cardiology, University British Columbia, Vancouver, Canada (J.L.); National Heart, Lung, Blood Institute, Institutes Health, Bethesda, Md (M.Y.C.); Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, (S.A.); Clinical Physiology, Nuclear Medicine PET Turku Centre, Hospital, Turku, Finland (J.K.); Royal Infirmary, Edinburgh, Scotland (D.N.).Address correspondence to J.H. (e-mail: [email protected]).Thomas StockerJonathon LeipsicMarcus ChenStephan AchenbachJuhani KnuutiDavid NewbyJörg Published Online:Jun 15 2021https://doi.org/10.1148/radiol.2021210245See editorial byU. Joseph SchoepfMoreSectionsPDF ToolsImage ViewerAdd favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In See also by Schoepf Decker this issue.IntroductionThe diagnostic value coronary angiography (CTA) strongly depends image quality, radiation dose should be as low reasonably achievable. rate was identified an independent predictor CTA quality exposure (1,2). However, scanner protocol improvements may bring question importance heart control, optimal patients undergoing is currently unclear. subanalysis Prospective Multicenter Registry Estimates Cardiac Angiography Daily Practice, or PROTECTION VI (3,4), we aimed identify allowing best reduction.Materials MethodsWe consecutively included first 50% examinations from each PROTECTION-VI study site enrolled between March December 2017 (clinical trial registration number NCT02996903). All sites were control their protocols. Images evaluated a core laboratory blinded scan reader with 5 years experience. A second reader, experience, re-evaluated 20% studies that adequately distributed among (interrater reliability coefficient, 0.81), senior experience consulted cases divergent results (n = 53). artery (left main artery, left anterior descending circumflex right artery) categorized (1, nondiagnostic; 2, adequate; 3, good; 4, excellent). Representative grading demonstrated Figure 1. Subsequently, score calculated averaging all four arteries. The signal-to-noise ratio, contrast-to-noise dose-length product analyzed described previous (5). Variables are expressed medians interquartile ranges (IQRs). Groups compared using Dunn Kruskal-Wallis multiple-comparison test, P values adjusted Bonferroni method. Linear regression analysis performed assess effect reduction dose. < .05 considered indicative statistically significant difference.Figure 1: angiographs show representative artery. A, Grade 1 (nondiagnostic); B, grade 2 (adequate); C, (good); D, 4 (excellent).Figure 1:Download PowerPointOpen Viewer ResultsWe 1911 57 sites. median patient age 59 (IQR, 50–68 years); 831 (43%) women. major manufacturers (837 [44%] imaged Siemens equipment, 557 [29%] GE Healthcare, 275 [14%] Canon, 242 [13%] Philips). 60 beats per minute 55–66 minute); 1798 (94%) sinus rhythm (unspecified 12 patients), 1370 (72%) received beta blocker therapy before CTA. 3.5 3.0–3.75), ratio 14 11–18), 11 8–15). 170 mGy · cm 99–310 cm). mode associated (retrospective helical: 376 cm; prospective axial: 107 46 .001).Patients grouped rates intervals five (≤45 minute: patients; 46–50 158 51–55 362 56–60 475 61–65 358 66–70 249 71–75 101 >75 149 patients). higher below (image score, ≥3.5) than those above (Fig A) (all .01). improvement (effect score: +0.18 10–beat decrease rate, .001), confirmed multivariable model various specifications (Table). tended stable non-sinus but did not reach difference (3.5 vs 3.25, respectively; .06). quantitative parameters similar groups B). threshold only A). linear analysis, reduced 48 (P .001).Figure 2: Lower improved (CTA). Median (green lines [top]) (red [bottom]) images separately five–beat (bpm) intervals. Multiple comparison testing significantly (median ≥3.5; .01) lower product, .001) when minute. * versus 3.25; .01. # 152 183 .001. Dots represent medians, vertical illustrate ranges. Signal-to-noise (SNR) (CNR) ratios (light blue line (dark groups. ranges.Figure 2:Download Effect Reduction Scanner Specifications AngiogramsDiscussionThe international, multivendor, real-world confirm notion has influence suggest cardiologists radiologists aim obtain simultaneously allow imaging. Therefore, use blockers absence contraindications variability. On basis our findings, recommend blockers, especially 75 minute, while might carefully increase likelihood quality—even modern high-resolution scanners.Disclosures Conflicts Interest: T.J.S. disclosed no relevant relationships. J.L. Activities related present article: consulting fees HeartFlow, Circle Imaging, MVRx; speaker Philips GE; stock options HeartFlow Imaging. Other relationships: M.Y.C. S.A. J.K. AstraZeneca review; Boehringer Ingelheim, Bayer, Lundbeck, Merck. D.N. Abbott Vascular Edwards Lifesciences. relationships.AcknowledgmentsWe thank Ronen Rubinshtein, MD; Martin Hadamitzky; Erik L. Grove; Russell Bull; Dustin Thomas; Gudrun Feuchtner; Christopher Naoum; Marcio S. Bittencourt; Signe H. Forsdahl; Simon Deseive; Steffen Massberg, MD, support preparation manuscript subinvestigators valuable contribution study.Author ContributionsAuthor contributions: Guarantors integrity entire study, T.J.S., J.H.; concepts/study design data acquisition analysis/interpretation, authors; drafting revision important intellectual content, approval final version submitted manuscript, agrees ensure any questions work appropriately resolved, literature research, J.L., S.A., clinical studies, M.Y.C., J.K., statistical editing, D.N., J.H.References1. Abbara S, Blanke P, Maroules CD, et al. SCCT guidelines performance computed tomographic angiography: report society Computed Tomography Guidelines Committee: Endorsed North American Society (NASCI). J Cardiovasc Comput Tomogr 2016;10(6):435–449. Crossref, Medline, Google Scholar2. Fujimoto Matsutani H, Kondo T, stratified 64- 320-MDCT angiography. AJR Am Roentgenol 2013;200(4):765–770. Scholar3. Stocker TJ, Deseive Leipsic J, cardiovascular tomography imaging: PRO-spective multicenter registry radiaTion cardiac angIOgraphy iN daily practice (PROTECTION VI). Eur 2018;39(41):3715–3723. Scholar4. Chen M, Rationale worldwide estimates 2018;12(1):81–85. Scholar5. Martinoff Hadamitzky tube voltage II Trial. JACC 2010;3(11):1113–1123. ScholarArticle HistoryReceived: Jan 28 2021Revision requested: Feb 22 received: Apr 08 2021Accepted: 21 2021Published online: June print: Sept 2021 FiguresReferencesRelatedDetailsCited ByRadiation CT: Unveiling 5-year Impact Patients Stable Chest PainJonathan D. 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