Radiation Exposure to Patients in a Multicenter Coronary Angiography Trial (CORE 64)

The objective of this study was to assess the exposure of patients to radiation for the cardiac CT acquisition protocol of the multicenter Coronary Artery Evaluation Using 64-Row Multidetector Computed Tomography Angiography (CORE 64) trial. An algorithm for patient dose assessment with Monte Carlo dosimetry was developed for the Aquilion 64-MDCT scanner. During the CORE 64 study, different acquisition protocols were used depending on patient size and sex; therefore, six patient models were constructed representing three men and three women in the categories of small, normal size, and obese. Organ dose and effective dose resulting from the cardiac CT protocol were assessed for these six patient models. The average effective dose for coronary CT angiography (CTA) calculated according to Report 103 of the International Commission on Radiological Protection (ICRP) is 19 mSv (range, 16-26 mSv). The average effective dose for the whole cardiac CT protocol including CT scanograms, bolus tracking, and calcium scoring is slightly higher-22 mSv (range, 18-30 mSv). An average conversion factor for the calculation of effective dose from dose-length product of 0.030 mSv/mGy · cm was derived for coronary CTA. The current methods of assessing patient dose are not well suited for cardiac CT acquisitions, and published effective dose values tend to underestimate effective dose. The effective dose of cardiac CT is approximately 25% higher when assessed according to the preferred ICRP Report 103 compared with ICRP Report 60. Underestimation of effective dose by 43% or 53% occurs in coronary CTA according to ICRP Report 103 when a conversion factor (E / DLP, where E is effective dose and DLP is dose-length product) for general chest CT of 0.017 or 0.014 mSv/mGy · cm, respectively, is used instead of 0.030 mSv/mGy · cm.