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Radiation Dose-Reduction Program for Cardiac Computed Tomography Angiography

Radiation Dose-Reduction Program for Cardiac Computed Tomography Angiography To the Editor: The study by Dr Raff and colleagues1 demonstrated that the implementation of a radiation dose-reduction program for cardiac computed tomography angiography (CCTA) may be effective. In addition, the authors noted that there was no significant change in the median image quality assessment in the control compared with the follow-up period. However, Table 2 indicates an increase in the proportion of studies with poor or nondiagnostic scores from the control period to the follow-up period (4.2% vs 7.7%, respectively). Although the median score of image quality remained unchanged, the observation that approximately 1 in every 13 studies were nondiagnostic in the follow-up period is of concern. Several potential causes (other than chance) may explain this relatively high number of nondiagnostic scans. First, modification of scan parameters such as tube voltage and tube current modulation with implementation of the dose-reduction protocol could have affected the perception of physicians who were accustomed to reporting CCTA with high parameters and less noise. The readers may have felt less comfortable with the newer parameters and may have classified some studies with diagnostic quality as nondiagnostic, particularly in low-volume centers where dose reduction was more substantial and where the learning curve may be greater. Second, the pronounced decrease in coronary calcium scoring from the control period to the follow-up period may have led to the performance of coronary angiography in patients with high calcium loads, in whom an increase in nondiagnostic coronary segments would be expected. Third, because the evaluation of image quality was not blinded, the results may have been biased. The study by Raff et al1 demonstrated that radiation dose reduction in CCTA is feasible and should be pursued. Nonetheless, a more profound evaluation of image quality and diagnostic utility of the scans, and perhaps continued medical education and training of readers, should be performed to ensure that the benefits of this extremely useful test remain unchanged. Back to top Article Information Financial Disclosures: Dr Paul reported receiving research support from Toshiba Medical Systems. No other disclosures were reported. References 1. Raff GL, Chinnaiyan KM, Share DA, et al; Advanced Cardiovascular Imaging Consortium Co-Investigators. Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. JAMA. 2009;301(22):2340-234819509381PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Radiation Dose-Reduction Program for Cardiac Computed Tomography Angiography

Torres, Felipe S.; Crean, Andrew M.; Paul, Narinder
JAMA , Volume 302 (16) – Oct 28, 2009
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Radiation Dose-Reduction Program for Cardiac Computed Tomography Angiography

Abstract

To the Editor: The study by Dr Raff and colleagues1 demonstrated that the implementation of a radiation dose-reduction program for cardiac computed tomography angiography (CCTA) may be effective. In addition, the authors noted that there was no significant change in the median image quality assessment in the control compared with the follow-up period. However, Table 2 indicates an increase in the proportion of studies with poor or nondiagnostic scores from the control period to the follow-up...
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References (3)

Publisher
American Medical Association
Copyright
Copyright © 2009 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2009.1512
Publisher site
See Article on Publisher Site

Abstract

To the Editor: The study by Dr Raff and colleagues1 demonstrated that the implementation of a radiation dose-reduction program for cardiac computed tomography angiography (CCTA) may be effective. In addition, the authors noted that there was no significant change in the median image quality assessment in the control compared with the follow-up period. However, Table 2 indicates an increase in the proportion of studies with poor or nondiagnostic scores from the control period to the follow-up period (4.2% vs 7.7%, respectively). Although the median score of image quality remained unchanged, the observation that approximately 1 in every 13 studies were nondiagnostic in the follow-up period is of concern. Several potential causes (other than chance) may explain this relatively high number of nondiagnostic scans. First, modification of scan parameters such as tube voltage and tube current modulation with implementation of the dose-reduction protocol could have affected the perception of physicians who were accustomed to reporting CCTA with high parameters and less noise. The readers may have felt less comfortable with the newer parameters and may have classified some studies with diagnostic quality as nondiagnostic, particularly in low-volume centers where dose reduction was more substantial and where the learning curve may be greater. Second, the pronounced decrease in coronary calcium scoring from the control period to the follow-up period may have led to the performance of coronary angiography in patients with high calcium loads, in whom an increase in nondiagnostic coronary segments would be expected. Third, because the evaluation of image quality was not blinded, the results may have been biased. The study by Raff et al1 demonstrated that radiation dose reduction in CCTA is feasible and should be pursued. Nonetheless, a more profound evaluation of image quality and diagnostic utility of the scans, and perhaps continued medical education and training of readers, should be performed to ensure that the benefits of this extremely useful test remain unchanged. Back to top Article Information Financial Disclosures: Dr Paul reported receiving research support from Toshiba Medical Systems. No other disclosures were reported. References 1. Raff GL, Chinnaiyan KM, Share DA, et al; Advanced Cardiovascular Imaging Consortium Co-Investigators. Radiation dose from cardiac computed tomography before and after implementation of radiation dose-reduction techniques. JAMA. 2009;301(22):2340-234819509381PubMedGoogle ScholarCrossref

Journal

JAMA – American Medical Association

Published: Oct 28, 2009

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