A comparison of radiation doses between state-of-the-art multislice CT coronary angiography with iterative reconstruction, multislice CT coronary angiography with standard filtered back-projection and invasive diagnostic coronary angiography.
OBJECTIVE
To accurately compare the radiation dose between prospectively gated cardiac multidetector CT (with and without iterative reconstruction) and diagnostic invasive coronary angiography using the latest International Commission on Radiological Protection 103 (ICRP) tissue weightings.


METHODS
A retrospective analysis of consecutive patients presenting to a university teaching hospital for investigation of coronary artery disease. Radiation doses for each technique were calculated using computational Monte Carlo modelling of a standard Cristy phantom rather than the application of previously published conversion factors. While these have frequently been used in other studies, they are based on out-dated ICRP tissue weightings (ICRP 60) and are for the whole chest rather than for structures irradiated in cardiac imaging. In order to allow a comparison, doses were calculated and expressed in terms of effective dose in millisieverts (mSv).


RESULTS
From a population presenting for angiography within a clinical service, the median radiation dose from cardiac CT with standard filtered back-projection (84 patients, 5.4 mSv) was comparable with the dose from invasive diagnostic coronary angiography (94 patients, 6.3 mSv). The dose for cardiac CT using iterative reconstruction was significantly lower (39 patients, 2.5 mSv).


CONCLUSIONS
The median effective dose from cardiac CT with standard filtered back-projection was comparable with the effective dose from invasive coronary angiography, even with application of the most contemporary ICRP tissue weightings and use of cardiac specific volumes. Cardiac CT scanning incorporating iterative reconstruction resulted in a significant reduction in the effective dose.
Royal Devon and Exeter NHS Foundation Trust, Cardiology SpR, Diabetes and Vascular Medicine, IBCS, Peninsula College of Medicine and Dentistry, Barrack Road, Exeter, UK. olivergosling@doctors.org.uk
O
O
Gosling
R
R
Loader
P
P
Venables
C
C
Roobottom
N
N
Rowles
N
N
Bellenger
G
G
Morgan-Hughes
D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009010:Monte Carlo Method; D011829:Radiation Dosage; D011874:Radiometry / Q000379:methods; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*