A prospective randomized trial comparing image quality, study interpretability, and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography
Abstract Background Prospectively triggered coronary computed tomography angiography (CTA) is commonly performed with a widened acquisition window to provide flexibility in image reconstruction. Objective We conducted a randomized controlled trial to determine whether the use of a narrow acquisition...
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| Veröffentlicht in: | Journal of cardiovascular computed tomography 2013, Vol.7 (1), p.18-24 |
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| creator | Leipsic, Jonathon, MD, FRCPC, FSCCT LaBounty, Troy M., MD, FSCCT Ajlan, Amr M Earls, James P., MD Strovski, E Madden, Mark Wood, David A., MD, FRCPC Hague, Cameron J Poulter, Rohan, MD Branch, Kelly, MD Cury, Ricardo C Heilbron, Brett, MD Taylor, Carolyn, MD, FRCPC Grunau, Gilat Haiducu, Lawrence Min, James K., MD, FSCCT |
| description | Abstract Background Prospectively triggered coronary computed tomography angiography (CTA) is commonly performed with a widened acquisition window to provide flexibility in image reconstruction. Objective We conducted a randomized controlled trial to determine whether the use of a narrow acquisition window in prospectively triggered coronary CTA would allow lower radiation dose while preserving image quality and interpretability. Methods Prospective 2-center 2- platform randomized trial that evaluated 205 consecutive patients 96 with widened acquisition (WA) and 109 narrow acquisition (NA) referred for coronary CTA in sinus rhythm and heart rate |
| doi_str_mv | 10.1016/j.jcct.2013.01.001 |
| format | Article |
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Objective We conducted a randomized controlled trial to determine whether the use of a narrow acquisition window in prospectively triggered coronary CTA would allow lower radiation dose while preserving image quality and interpretability. Methods Prospective 2-center 2- platform randomized trial that evaluated 205 consecutive patients 96 with widened acquisition (WA) and 109 narrow acquisition (NA) referred for coronary CTA in sinus rhythm and heart rate <65 beats/min. Patients scanned with WA had phases reconstructed at 5% intervals, and each phase was assigned an individual study ID. Images were reviewed with individual phase reconstructions interpreted randomly by 2 level 3 readers with a third for consensus. Images were evaluated with a 5-point Likert scale on a per-vessel basis (best score on any phase). Scores were then dichotomized into diagnostic (score 3–5) compared with nondiagnostic (score 1–2). Readers also reported obstructive coronary artery disease on a per-patient basis. Agreement for the diagnosis of obstructive disease and per-artery interpretability was performed. Signal and noise measurements were also performed. Results No difference in demographics between groups ( P = NS). The signal-to-noise ratio was comparable 12.99 ± 3.4 NA and 12.53 ± 4.13 for the WA ( P = 0.45). The median effective dose was 1.78 mSv for NA compared with 3.26 mSv for WA ( P < 0.001). Image quality, diagnostic interpretability, interreader agreement, and downstream testing were not significantly different between the 2 groups ( P = NS for all). Conclusions Coronary CTA with NA resulted in a 47% lower radiation dose without significant difference in study interpretability or image quality or increased downstream resource use or testing.</description><identifier>ISSN: 1934-5925</identifier><identifier>EISSN: 1876-861X</identifier><identifier>DOI: 10.1016/j.jcct.2013.01.001</identifier><identifier>PMID: 23452996</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Cardiac-Gated Imaging Techniques - statistics & numerical data ; Cardiovascular ; Coronary Angiography - statistics & numerical data ; Coronary Artery Disease - diagnostic imaging ; Coronary Artery Disease - epidemiology ; Coronary CTA ; Female ; Humans ; Image quality ; Male ; Middle Aged ; Observer Variation ; Prevalence ; Prospective Studies ; Radiation Dosage ; Radiation dose ; Radiation Protection - statistics & numerical data ; Radiometry - statistics & numerical data ; Reproducibility of Results ; Risk Factors ; Sensitivity and Specificity ; Tomography, X-Ray Computed - statistics & numerical data ; United States - epidemiology ; Young Adult</subject><ispartof>Journal of cardiovascular computed tomography, 2013, Vol.7 (1), p.18-24</ispartof><rights>2013</rights><rights>Copyright © 2013. Published by Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c411t-6579329ee8acf5daf7ac3d854eacf823735070757bbe5d2b5f0de4dcd0da86a53</citedby><cites>FETCH-LOGICAL-c411t-6579329ee8acf5daf7ac3d854eacf823735070757bbe5d2b5f0de4dcd0da86a53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1934592513000026$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,4010,27900,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23452996$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leipsic, Jonathon, MD, FRCPC, FSCCT</creatorcontrib><creatorcontrib>LaBounty, Troy M., MD, FSCCT</creatorcontrib><creatorcontrib>Ajlan, Amr M</creatorcontrib><creatorcontrib>Earls, James P., MD</creatorcontrib><creatorcontrib>Strovski, E</creatorcontrib><creatorcontrib>Madden, Mark</creatorcontrib><creatorcontrib>Wood, David A., MD, FRCPC</creatorcontrib><creatorcontrib>Hague, Cameron J</creatorcontrib><creatorcontrib>Poulter, Rohan, MD</creatorcontrib><creatorcontrib>Branch, Kelly, MD</creatorcontrib><creatorcontrib>Cury, Ricardo C</creatorcontrib><creatorcontrib>Heilbron, Brett, MD</creatorcontrib><creatorcontrib>Taylor, Carolyn, MD, FRCPC</creatorcontrib><creatorcontrib>Grunau, Gilat</creatorcontrib><creatorcontrib>Haiducu, Lawrence</creatorcontrib><creatorcontrib>Min, James K., MD, FSCCT</creatorcontrib><title>A prospective randomized trial comparing image quality, study interpretability, and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography</title><title>Journal of cardiovascular computed tomography</title><addtitle>J Cardiovasc Comput Tomogr</addtitle><description>Abstract Background Prospectively triggered coronary computed tomography angiography (CTA) is commonly performed with a widened acquisition window to provide flexibility in image reconstruction. Objective We conducted a randomized controlled trial to determine whether the use of a narrow acquisition window in prospectively triggered coronary CTA would allow lower radiation dose while preserving image quality and interpretability. Methods Prospective 2-center 2- platform randomized trial that evaluated 205 consecutive patients 96 with widened acquisition (WA) and 109 narrow acquisition (NA) referred for coronary CTA in sinus rhythm and heart rate <65 beats/min. Patients scanned with WA had phases reconstructed at 5% intervals, and each phase was assigned an individual study ID. Images were reviewed with individual phase reconstructions interpreted randomly by 2 level 3 readers with a third for consensus. Images were evaluated with a 5-point Likert scale on a per-vessel basis (best score on any phase). Scores were then dichotomized into diagnostic (score 3–5) compared with nondiagnostic (score 1–2). Readers also reported obstructive coronary artery disease on a per-patient basis. Agreement for the diagnosis of obstructive disease and per-artery interpretability was performed. Signal and noise measurements were also performed. Results No difference in demographics between groups ( P = NS). The signal-to-noise ratio was comparable 12.99 ± 3.4 NA and 12.53 ± 4.13 for the WA ( P = 0.45). The median effective dose was 1.78 mSv for NA compared with 3.26 mSv for WA ( P < 0.001). Image quality, diagnostic interpretability, interreader agreement, and downstream testing were not significantly different between the 2 groups ( P = NS for all). Conclusions Coronary CTA with NA resulted in a 47% lower radiation dose without significant difference in study interpretability or image quality or increased downstream resource use or testing.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cardiac-Gated Imaging Techniques - statistics & numerical data</subject><subject>Cardiovascular</subject><subject>Coronary Angiography - statistics & numerical data</subject><subject>Coronary Artery Disease - diagnostic imaging</subject><subject>Coronary Artery Disease - epidemiology</subject><subject>Coronary CTA</subject><subject>Female</subject><subject>Humans</subject><subject>Image quality</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Observer Variation</subject><subject>Prevalence</subject><subject>Prospective Studies</subject><subject>Radiation Dosage</subject><subject>Radiation dose</subject><subject>Radiation Protection - statistics & numerical data</subject><subject>Radiometry - statistics & numerical data</subject><subject>Reproducibility of Results</subject><subject>Risk Factors</subject><subject>Sensitivity and Specificity</subject><subject>Tomography, X-Ray Computed - statistics & numerical data</subject><subject>United States - epidemiology</subject><subject>Young Adult</subject><issn>1934-5925</issn><issn>1876-861X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9Uk1v1DAQjRCIlsIf4IB85ECC7cT5kBBStSoFqRIHQOJmee1J6iWJs7bTVfjX_AMm3QUhhPDBY3tm3ryZ5yR5zmjGKCtf77Kd1jHjlOUZZRml7EFyzuqqTOuSfX2I5yYvUtFwcZY8CWFHqagYrR8nZzwvBG-a8jz5cUkm78IEOto7IF6Nxg32OxgSvVU90W6YlLdjR-ygOiD7WfU2Lq9IiLNZiB0j-MlDVFt7fEcARDFWRetGYlwA4loyKu_dgSi9n22w966DxVIHNPEWNwMj1vyHH9lFp10fsNafVPuFXG2uU2TZdeAxVzvvsMxyT3mOawducJ1X0-2CrDp7Oj9NHrWqD_DsZC-SL--uPm_epzcfrz9sLm9SXTAW01JUTc4bgFrpVhjVVkrnphYF4L3meZULWtFKVNstCMO3oqUGCqMNNaoulcgvkpdHXCS9nyFEOdigoe_VCG4OkuWsqGjNS46h_Biqsb_goZWTx3H7RTIqV6nlTq5Sy1VqSZlEqTHpxQl_3g5gfqf80hYD3hwDALu8s-Bl0BZGDcZ6nKE0zv4f_-1f6bq3o9Wq_wYLhJ2b_Yjzk0wGLqn8tH629a-xnOLiZf4TXRLZng</recordid><startdate>2013</startdate><enddate>2013</enddate><creator>Leipsic, Jonathon, MD, FRCPC, FSCCT</creator><creator>LaBounty, Troy M., MD, FSCCT</creator><creator>Ajlan, Amr M</creator><creator>Earls, James P., MD</creator><creator>Strovski, E</creator><creator>Madden, Mark</creator><creator>Wood, David A., MD, FRCPC</creator><creator>Hague, Cameron J</creator><creator>Poulter, Rohan, MD</creator><creator>Branch, Kelly, MD</creator><creator>Cury, Ricardo C</creator><creator>Heilbron, Brett, MD</creator><creator>Taylor, Carolyn, MD, FRCPC</creator><creator>Grunau, Gilat</creator><creator>Haiducu, Lawrence</creator><creator>Min, James K., MD, FSCCT</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>2013</creationdate><title>A prospective randomized trial comparing image quality, study interpretability, and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography</title><author>Leipsic, Jonathon, MD, FRCPC, FSCCT ; LaBounty, Troy M., MD, FSCCT ; Ajlan, Amr M ; Earls, James P., MD ; Strovski, E ; Madden, Mark ; Wood, David A., MD, FRCPC ; Hague, Cameron J ; Poulter, Rohan, MD ; Branch, Kelly, MD ; Cury, Ricardo C ; Heilbron, Brett, MD ; Taylor, Carolyn, MD, FRCPC ; Grunau, Gilat ; Haiducu, Lawrence ; Min, James K., MD, FSCCT</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c411t-6579329ee8acf5daf7ac3d854eacf823735070757bbe5d2b5f0de4dcd0da86a53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cardiac-Gated Imaging Techniques - statistics & numerical data</topic><topic>Cardiovascular</topic><topic>Coronary Angiography - statistics & numerical data</topic><topic>Coronary Artery Disease - diagnostic imaging</topic><topic>Coronary Artery Disease - epidemiology</topic><topic>Coronary CTA</topic><topic>Female</topic><topic>Humans</topic><topic>Image quality</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Observer Variation</topic><topic>Prevalence</topic><topic>Prospective Studies</topic><topic>Radiation Dosage</topic><topic>Radiation dose</topic><topic>Radiation Protection - statistics & numerical data</topic><topic>Radiometry - statistics & numerical data</topic><topic>Reproducibility of Results</topic><topic>Risk Factors</topic><topic>Sensitivity and Specificity</topic><topic>Tomography, X-Ray Computed - statistics & numerical data</topic><topic>United States - epidemiology</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leipsic, Jonathon, MD, FRCPC, FSCCT</creatorcontrib><creatorcontrib>LaBounty, Troy M., MD, FSCCT</creatorcontrib><creatorcontrib>Ajlan, Amr M</creatorcontrib><creatorcontrib>Earls, James P., MD</creatorcontrib><creatorcontrib>Strovski, E</creatorcontrib><creatorcontrib>Madden, Mark</creatorcontrib><creatorcontrib>Wood, David A., MD, FRCPC</creatorcontrib><creatorcontrib>Hague, Cameron J</creatorcontrib><creatorcontrib>Poulter, Rohan, MD</creatorcontrib><creatorcontrib>Branch, Kelly, MD</creatorcontrib><creatorcontrib>Cury, Ricardo C</creatorcontrib><creatorcontrib>Heilbron, Brett, MD</creatorcontrib><creatorcontrib>Taylor, Carolyn, MD, FRCPC</creatorcontrib><creatorcontrib>Grunau, Gilat</creatorcontrib><creatorcontrib>Haiducu, Lawrence</creatorcontrib><creatorcontrib>Min, James K., MD, FSCCT</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular computed tomography</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leipsic, Jonathon, MD, FRCPC, FSCCT</au><au>LaBounty, Troy M., MD, FSCCT</au><au>Ajlan, Amr M</au><au>Earls, James P., MD</au><au>Strovski, E</au><au>Madden, Mark</au><au>Wood, David A., MD, FRCPC</au><au>Hague, Cameron J</au><au>Poulter, Rohan, MD</au><au>Branch, Kelly, MD</au><au>Cury, Ricardo C</au><au>Heilbron, Brett, MD</au><au>Taylor, Carolyn, MD, FRCPC</au><au>Grunau, Gilat</au><au>Haiducu, Lawrence</au><au>Min, James K., MD, FSCCT</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A prospective randomized trial comparing image quality, study interpretability, and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography</atitle><jtitle>Journal of cardiovascular computed tomography</jtitle><addtitle>J Cardiovasc Comput Tomogr</addtitle><date>2013</date><risdate>2013</risdate><volume>7</volume><issue>1</issue><spage>18</spage><epage>24</epage><pages>18-24</pages><issn>1934-5925</issn><eissn>1876-861X</eissn><abstract>Abstract Background Prospectively triggered coronary computed tomography angiography (CTA) is commonly performed with a widened acquisition window to provide flexibility in image reconstruction. Objective We conducted a randomized controlled trial to determine whether the use of a narrow acquisition window in prospectively triggered coronary CTA would allow lower radiation dose while preserving image quality and interpretability. Methods Prospective 2-center 2- platform randomized trial that evaluated 205 consecutive patients 96 with widened acquisition (WA) and 109 narrow acquisition (NA) referred for coronary CTA in sinus rhythm and heart rate <65 beats/min. Patients scanned with WA had phases reconstructed at 5% intervals, and each phase was assigned an individual study ID. Images were reviewed with individual phase reconstructions interpreted randomly by 2 level 3 readers with a third for consensus. Images were evaluated with a 5-point Likert scale on a per-vessel basis (best score on any phase). Scores were then dichotomized into diagnostic (score 3–5) compared with nondiagnostic (score 1–2). Readers also reported obstructive coronary artery disease on a per-patient basis. Agreement for the diagnosis of obstructive disease and per-artery interpretability was performed. Signal and noise measurements were also performed. Results No difference in demographics between groups ( P = NS). The signal-to-noise ratio was comparable 12.99 ± 3.4 NA and 12.53 ± 4.13 for the WA ( P = 0.45). The median effective dose was 1.78 mSv for NA compared with 3.26 mSv for WA ( P < 0.001). Image quality, diagnostic interpretability, interreader agreement, and downstream testing were not significantly different between the 2 groups ( P = NS for all). Conclusions Coronary CTA with NA resulted in a 47% lower radiation dose without significant difference in study interpretability or image quality or increased downstream resource use or testing.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>23452996</pmid><doi>10.1016/j.jcct.2013.01.001</doi><tpages>7</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Cardiac-Gated Imaging Techniques - statistics & numerical data Cardiovascular Coronary Angiography - statistics & numerical data Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - epidemiology Coronary CTA Female Humans Image quality Male Middle Aged Observer Variation Prevalence Prospective Studies Radiation Dosage Radiation dose Radiation Protection - statistics & numerical data Radiometry - statistics & numerical data Reproducibility of Results Risk Factors Sensitivity and Specificity Tomography, X-Ray Computed - statistics & numerical data United States - epidemiology Young Adult |
| title | A prospective randomized trial comparing image quality, study interpretability, and radiation dose of narrow acquisition window with widened acquisition window protocols in prospectively ECG-triggered coronary computed tomography angiography |
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