title: Prospective ECG triggering versus low-dose retrospective ECG-gated 128-channel CT coronary angiography: comparison of image quality and radiation dose.
abstract: OBJECTIVE
  To evaluate image quality and radiation dose for 128-detector prospective electrocardiogram (ECG)-gated computed tomography coronary angiography (CTCA) compared with a low-dose retrospective ECG-gated imaging protocol.
  
  
  METHODS
  Thirty-one and 47 patients suspected of having coronary artery disease were enrolled into groups examined using prospective and low-dose retrospective ECG-gated CT protocols respectively. All examinations were performed on a 128-detector CT system (Definition AS, Siemens Healthcare, Forchheim, Germany). Prospective CTCA was performed using following parameters: tube voltage 100 kV; tube current 205 mAs; centre of acquisition window 70% of the RR interval. The tube current for low-dose retrospective ECG-gated CTCA was full dose during 40-70% of the RR interval and partial dose for the rest of RR interval. The pitch varied between 0.2 and 0.5 depending on heart rate and patient size. Image quality of coronary arteries was evaluated using a four-point grading scale. The signal-to-noise ratios (SNRs) of enhanced arteries and myocardium were also measured, corresponding contrast-to-noise ratios (CNRs) were calculated, and the radiation doses received were recorded.
  
  
  RESULTS
  There was a significant difference in the image quality scores between the retrospective and prospective gating protocols (Chi-square=15.331, p=0.009). There was no significant difference between the SNRs of the contrasted artery and myocardium in these two groups, but the CNRs were increased in the prospective group. The mean radiation dose of prospective gating group was 2.71+/-0.67 mSv (range, 1.67-3.59 mSv), which was significantly lower than that of the retrospective group (p<0.001).
  
  
  CONCLUSIONS
  Prospective CT angiography can achieve lower radiation dose than that of low-dose retrospective CT angiography, with preserved image quality.
authors.affiliation: Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Q
authors.initials: Q
authors.lastname: Feng
authors.forename: Y
authors.initials: Y
authors.lastname: Yin
authors.forename: X
authors.initials: X
authors.lastname: Hua
authors.forename: R
authors.initials: R
authors.lastname: Zhu
authors.forename: J
authors.initials: J
authors.lastname: Hua
authors.forename: J
authors.initials: J
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D017023:Coronary Angiography / Q000295:instrumentation / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000592:standards*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*