Coronary CT radiation dose reduction strategies at an Australian Tertiary Care Center – improvements in radiation exposure through an evidence‐based approach. Issue 1 (6th November 2019)

• Record Type: Journal Article
• Authors: Hamilton‐Craig, Christian R.; Tandon, Karman; Kwan, Bianca; DeBoni, Karen; Burley, Chris; Wesley, Allan J.; O'Rourke, Rachael; Neill, Johanne; Branch, Kelley R.
• Other Names: Dobeli Dr Karen guestEditor.; Brown Dr Elizabeth guestEditor.
• Is Part Of: Journal of medical radiation sciences. Volume 67:Issue 1(2020:Mar.)
• Page Start: 25
• Page End: 33
• Publication Date: 2019-11-06
• Subjects: cardiovascular computed tomography -- coronary CT -- education -- prospectively triggered coronary CT -- radiation dose -- tube voltage; Radiology, Medical -- Periodicals; Radiology, Medical -- Australia -- Periodicals; Radiology, Medical -- New Zealand -- Periodicals; Radiotherapy -- Periodicals; Diagnostic imaging -- Periodicals; 616
• DOI: 10.1002/jmrs.358
• Languages: English
• ISSNs: 2051-3895

Abstract

Abstract: Introduction: Coronary CT Angiography (CCTA) is a rapidly increasing technique for coronary imaging; however, it exposes patients to ionising radiation. We examined the impact of dose reduction techniques using ECG‐triggering, kVp/mAs reduction and high‐pitch modes on radiation exposure in a large Australian tertiary CCTA service. Methods: Data on acquisition modes and dose exposure were prospectively collected on all CCTA scans from November 2009 to March 2014 at an Australian tertiary care centre. A dose reduction algorithm was developed using published techniques and implemented with education of medical staff, radiographers and referrers. Associations of CCTA acquisition to radiation over time were analysed with multivariate regression. Specificity in positive CCTA was assessed by correlation with invasive coronary angiography. Results: 3333 CCTAs were analysed. Mean radiation dose decreased from 8.4 mSv to 5.3, 4.4, 3.7, 2.9 and 2.8 mSv ( P < 0.001) per year. Patient characteristics were unchanged. Dose reduction strategies using ECG‐triggering, kVp/mAs reduction accounted for 91% of the decrease. High‐pitch scanning reduced dose by an additional 9%. Lower dose was independently related to lower kVp, heart rate, tube current modulation, BMI, prospective triggering and high‐pitch mode ( P < 0.01). CCTA specificity remained unchanged despite dose reduction. Conclusion: Implementation of evidence‐based CCTA dose reduction algorithm and staff education programme resulted in a 67% reduction in radiation exposure, while maintaining diagnostic specificity. This approach is widely applicable to clinical practice for the performance of CCTA. Abstract : Cardiac CT angiography dosing was reviewed after implementation of dose reduction strategies. 3333 CCTAs were analyzed. Implementation of evidence‐based dose reduction strategies and a decision‐support algorithm accounted for 91% of dose reduction, with 9% attributable to hardware. Significant reductions in radiation exposure are feasible in real‐world clinical practice and can be successfully applied through better education and training.