Document Detail

Effect of a standardized quality-improvement protocol on radiation dose in coronary computed tomographic angiography.
MedLine Citation:
PMID:  21094371     Owner:  NLM     Status:  MEDLINE    
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 index-based and heart rate-based 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.
Troy M LaBounty; James P Earls; Jonathon Leipsic; Brett Heilbron; G B John Mancini; Fay Y Lin; Allison M Dunning; James K Min
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2010-10-14
Journal Detail:
Title:  The American journal of cardiology     Volume:  106     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-11-24     Completed Date:  2011-01-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1663-7     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2010 Elsevier Inc. All rights reserved.
Department of Medicine, Division of Cardiology, Weill Cornell Medical College at New York Presbyterian Hospital, New York, New York, USA.
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MeSH Terms
Body Mass Index
Coronary Angiography / methods,  standards*
Coronary Artery Disease / radiography*
Follow-Up Studies
Middle Aged
Prospective Studies
Quality Improvement*
Radiation Dosage*
Radiation Protection / methods*
Risk Factors
Tomography, X-Ray Computed / methods,  standards*

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