title: Triple-rule-out dual-source CT angiography of patients with acute chest pain: dose reduction potential of 100 kV scanning.
abstract: OBJECTIVE
  To investigate the dose reduction potential of low kV triple-rule-out dual-source CT angiography (TRO-CTA) in non-obese (BMI ≤ 25 kg/m(2)) patients with acute chest pain.
  
  
  METHODS
  Sixty consecutive patients were randomly assigned to two different retrospectively ECG-gated TRO-CTA protocols in this prospective trial: Thirty patients were examined with a 120-kV standard protocol (320 reference mAs with automatic tube current modulation, automatically adapted pitch and ECG-pulsing) and served as the control group (group 1), an otherwise identical 100 kV protocol was used in the other thirty patients (group 2) for a radiation dose reduction. Subjective image quality was assessed on a 5 point scale (1: excellent, 5: non-diagnostic) by two blinded observers. Quantitative image analysis assessed vascular attenuation, signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in different vascular segments. The effective dose was calculated from the dose length product (DLP) using a conversion coefficient of 0.017 mSvmGy(-1)cm(-1).
  
  
  RESULTS
  There was no significant difference of age, BMI, heart rate, pitch or scan length between both patient groups. Subjective image quality was rated similar in both groups (group 1: 1.2 ± 0.4, group 2: average score=1.3 ± 0.5). Vessel attenuation was significantly higher in group 2 than in group 1 (ascending aorta: 456 ± 83 HU vs. 370 ± 78 HU, p<0.001; pulmonary artery: 468 ± 118 HU vs. 411 ± 91 HU, p=0.03; left coronary artery: 437 ± 110 HU vs. 348 ± 89 HU, p<0.001), however, there was no significant difference in SNR (13.2 ± 7.6 vs. 14.5 ± 7.5, p=0.49) or CNR (13.8 ± 6.6 vs. 15.9 ± 7.7, p=0.25). The effective radiation dose of the 100 kV protocol was significantly lower (9.6 ± 3.2 mSv vs. 18.1 ± 9.4 mSv, p<0.0001).
  
  
  CONCLUSIONS
  TRO-CTA with 100 kV is feasible in non-obese patients and results in diagnostic image quality and significantly reduced radiation dose.
authors.affiliation: Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Germany. radko.krissak@umm.de
authors.forename: Radko
authors.initials: R
authors.lastname: Krissak
authors.forename: Thomas
authors.initials: T
authors.lastname: Henzler
authors.forename: Anne
authors.initials: A
authors.lastname: Prechel
authors.forename: Miriam
authors.initials: M
authors.lastname: Reichert
authors.forename: Joachim
authors.initials: J
authors.lastname: Gruettner
authors.forename: Tim
authors.initials: T
authors.lastname: Sueselbeck
authors.forename: Stefan O
authors.initials: SO
authors.lastname: Schoenberg
authors.forename: Christian
authors.initials: C
authors.lastname: Fink
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D055424:Cardiac-Gated Imaging Techniques / Q000379:methods*; D002637:Chest Pain / Q000000981:diagnostic imaging*; D006801:Humans; D008875:Middle Aged; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*