Effect of a standardized quality-improvement protocol on radiation dose in coronary computed tomographic angiography

Troy M. Labounty, James P. Earls, Jonathon Leipsic, Brett Heilbron, G. B.John Mancini, Fay Y. Lin, Allison M. Dunning, James K. Min

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Coronary computed tomographic angiography (CCTA) is associated with ionizing radiation, prompting concerns of future cancer risk. Recent studies have reported reduced radiation doses and similar image quality by the selective use of dose reduction techniques, although the clinical penetration of these methods has been limited. In a quality improvement initiative, a comprehensive, standardized radiation dose reduction protocol was implemented, and its effect on radiation dose and image quality was assessed. A total of 449 patients who underwent 64-detector CCTA at 3 centers were prospectively evaluated, and patients were compared before (n = 247) and after (n = 202) the implementation of a standardized body mass indexbased and heart ratebased protocol that simultaneously incorporated multiple dose reduction strategies. Median radiation dose decreased from 2.6 mSv (interquartile range 2.0 to 4.2) to 1.3 mSv (interquartile range 0.8 to 1.9) after the implementation of the standardized protocol (p <0.001). On multivariate analysis, reduction in overall radiation dose was observed by numerous dose reduction techniques, with varying efficacy of dose lowering: prospective (vs retrospective) electrocardiographic gating (-82%), reduced tube voltage (-41% for 100 vs 120 kV), lower tube current (-25% per -100 mA), and reduced overall scan length (-6% per -1 cm) (p <0.001 for each). No differences were observed between patients before and after the initiation of the protocol for study interpretability (96% vs 96%, p = 0.66). There was an increase in signal-to-noise ratio after implementing the standardized protocol (11 ± 3 vs 12 ± 4, p <0.01). In conclusion, a quality improvement protocol for CCTA incorporating multiple dose reduction techniques permits significant radiation dose reduction and may improve the safety profile of CCTA.

Original languageEnglish
Pages (from-to)1663-1667
Number of pages5
JournalAmerican Journal of Cardiology
Volume106
Issue number11
DOIs
StatePublished - 1 Dec 2010
Externally publishedYes

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