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Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 (PROTECTION VI)

2018; Oxford University Press; Volume: 39; Issue: 41 Linguagem: Inglês

10.1093/eurheartj/ehy546

1522-9645

Thomas J. Stocker, Simon Deseive, Jonathon Leipsic, Martin Hadamitzky, Marcus Y. Chen, Ronen Rubinshtein, Mathias Heckner, Jeroen J. Bax, Xiangming Fang, Erik Lerkevang Grove, John R. Lesser, Pál Maurovich‐Horvat, James Otton, Sanghoon Shin, Gianluca Pontone, Hugo Marques, Benjamin J.W. Chow, César Higa Nomura, Ramzi Tabbalat, Axel Schmermund, Joon‐Won Kang, Christopher Naoum, Melany Atkins, Eugenio Martuscelli, Steffen Maßberg, Jörg Hausleiter, Patrícia Carrascosa, Alejandro Deviggiano, Christopher Naoum, John Magnussen, James Otton, Anthony Kaplan, Gudrun Feuchtner, Fabian Plank, K. De Smet, Nico Buls, Roberto Caldeira Cury, Márcio Sommer Bittencourt, César Higa Nomura, Roberto Nery Dantas, Jonathon Leipsic, Philipp Blanke, Carl Chartrand‐Lefebvre, Anne S. Chin, Gary R. Small, Benjamin J.W. Chow, Claudio Silva F, Marcelo Godoy, Claudio Silva F, Xiangming Fang, Wang Jie, Alberto Cadena, Theodor Adla, Vojtěch Suchánek, Erik Lerkevang Grove, Kamilla Bech Pedersen, Jess Lambrechtsen, Mirza Husic, Juhani Knuuti, Teemu Maaniitty, Bernhard Bischoff, Elisabeth Arnoldi, Axel Schmermund, J. Eckert, Martin Hadamitzky, Tom Finck, Michaela M. Hell, Mohamed Marwan, Fabian Bamberg, Stefanie Mangold, Thomas Schlosser, Johannes Ludwig, Maria Mylona, Spyros Skiadopoulos, Pál Maurovich‐Horvat, Bálint Szilveszter, Uday Jadav, Brian V Pinto, Ronen Rubinshtein, Essam Hussein, Daniele Andreini, Gianluca Pontone, Eugenio Martuscelli, Massimiliano Sperandio, Kakuya Kitagawa, Naoki Nagasawa, Ramzi Tabbalat, Rami A Farhan, Lilia M Sierra Galán, Leovigildo A Delgado, Lilia M Sierra Galán, Marco A Reza Orozco, Francisco C Castellón, Mariana Diaz Zamudio, Andrés Preciado-Anaya, Rafael P Gómez, Signe Helene Forsdahl, Grete Anita Hansen, Anne Günther, Joanna Fenn Kristiansen, Edith Chavez Huapalla, Percy Teran Chavez, Hugo Marques, Pedro de Araújo Gonçalves, Subramaniyan Ramanathan, В. Е. Синицын, Maria Glazkova, Rami M. Abazid, Osama A. Smettei, Ahmed Dawood, Salama Hussain Omar, Joon‐Won Kang, Dong Hyun Yang, Tae‐Hoon Kim, Chul Hwan Park, Sanghoon Shin, Seok Jong Ryu, Jose R Palomares, Hug Cuéllar, Jeroen J. Bax, Alexander van Rosendael, Michelle C. Williams, David E. Newby, Edwin J.R. van Beek, Russell Bull, Kavin Jayawardhana, Patricia Dickson, Jennifer Espey, John R. Lesser, Bo Han, Renée P. Bullock-Palmer, Mark Rabbat, Nancy Schoenecker, Dustin Thomas, Rosco Gore, Melany Atkins, Marcus Y. Chen, Sujata M. Shanbhag, John J. Mahmarian, Jeannie Yu, Todd C. Villines, Binh T. Nguyen,

Advanced X-ray and CT Imaging

Advances of cardiac computed tomography angiography (CTA) have been developed for dose reduction, but their efficacy in clinical practice is largely unknown. This study was designed to evaluate radiation dose exposure and utilization of dose-saving strategies for contrast-enhanced cardiac CTA in daily practice. Sixty one hospitals from 32 countries prospectively enrolled 4502 patients undergoing cardiac CTA during one calendar month in 2017. Computed tomography angiography scan data and images were analysed in a central core lab and compared with a similar dose survey performed in 2007. Linear regression analysis was performed to identify independent predictors associated with dose. The most frequent indication for cardiac CTA was the evaluation of coronary artery disease in 89% of patients. The median dose-length product (DLP) of coronary CTA was 195 mGy*cm (interquartile range 110–338 mGy*cm). When compared with 2007, the DLP was reduced by 78% (P < 0.001) without an increase in non-diagnostic coronary CTAs (1.7% in 2007 vs. 1.9% in 2017 surveys, P = 0.55). A 37-fold variability in median DLP was observed between the hospitals with lowest and highest DLP (range of median DLP 57–2090 mGy*cm). Independent predictors for radiation dose of coronary CTA were: body weight, heart rate, sinus rhythm, tube voltage, iterative image reconstruction, and the selection of scan protocols. This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.