Coronary CT radiation dose reduction strategies at an Australian Tertiary Care Center - improvements in radiation exposure through an evidence-based approach.

Autor: Hamilton-Craig CR; The Prince Charles Hospital, Brisbane, Queensland, Australia.; University of Queensland, Brisbane, Queensland, Australia.; Griffith University School of Medicine, Sunshine Coast, Queensland, Australia., Tandon K; University of Washington, Seattle, Washington, USA., Kwan B; The Prince Charles Hospital, Brisbane, Queensland, Australia.; University of Queensland, Brisbane, Queensland, Australia., DeBoni K; The Prince Charles Hospital, Brisbane, Queensland, Australia., Burley C; The Prince Charles Hospital, Brisbane, Queensland, Australia., Wesley AJ; The Prince Charles Hospital, Brisbane, Queensland, Australia.; University of Queensland, Brisbane, Queensland, Australia., O'Rourke R; The Prince Charles Hospital, Brisbane, Queensland, Australia.; University of Queensland, Brisbane, Queensland, Australia., Neill J; The Prince Charles Hospital, Brisbane, Queensland, Australia.; University of Queensland, Brisbane, Queensland, Australia., Branch KR; University of Washington, Seattle, Washington, USA.
Jazyk: angličtina
Zdroj: Journal of medical radiation sciences [J Med Radiat Sci] 2020 Mar; Vol. 67 (1), pp. 25-33. Date of Electronic Publication: 2019 Nov 06.
DOI: 10.1002/jmrs.358
Abstrakt: Introduction: Coronary CT Angiography (CCTA) is a rapidly increasing technique for coronary imaging; however, it exposes patients to ionising radiation. We examined the impact of dose reduction techniques using ECG-triggering, kVp/mAs reduction and high-pitch modes on radiation exposure in a large Australian tertiary CCTA service.
Methods: Data on acquisition modes and dose exposure were prospectively collected on all CCTA scans from November 2009 to March 2014 at an Australian tertiary care centre. A dose reduction algorithm was developed using published techniques and implemented with education of medical staff, radiographers and referrers. Associations of CCTA acquisition to radiation over time were analysed with multivariate regression. Specificity in positive CCTA was assessed by correlation with invasive coronary angiography.
Results: 3333 CCTAs were analysed. Mean radiation dose decreased from 8.4 mSv to 5.3, 4.4, 3.7, 2.9 and 2.8 mSv (P < 0.001) per year. Patient characteristics were unchanged. Dose reduction strategies using ECG-triggering, kVp/mAs reduction accounted for 91% of the decrease. High-pitch scanning reduced dose by an additional 9%. Lower dose was independently related to lower kVp, heart rate, tube current modulation, BMI, prospective triggering and high-pitch mode (P < 0.01). CCTA specificity remained unchanged despite dose reduction.
Conclusion: Implementation of evidence-based CCTA dose reduction algorithm and staff education programme resulted in a 67% reduction in radiation exposure, while maintaining diagnostic specificity. This approach is widely applicable to clinical practice for the performance of CCTA.
(© 2019 The Authors and State of Queensland Journal of Medical Radiation Sciences published by John Wiley & Sons Australia, Ltd on behalf of Australian Society of Medical Imaging and Radiation Therapy and New Zealand Institute of Medical Radiation Technology.)
Databáze: MEDLINE
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