title: Prospectively gated coronary computed tomography angiography: uncompromised quality with markedly reduced radiation exposure in acute chest pain evaluation.
abstract: BACKGROUND
  Coronary computed tomography angiography (CCTA) is an established modality for ruling out coronary artery disease. However, it has been suggested that CCTA may be a source of non-negligible radiation exposure.
  
  
  OBJECTIVE
  To evaluate the potential degradation in coronary image quality when using prospective gated (PG) CCTA as compared with retrospective gated (RG) CCTA in chest pain evaluation.
  
  
  METHODS
  The study cohort comprised 216 patients: 108 consecutive patients in the PG CCTA arm and 108 patients matched for age, gender and heart rate in the RG CCTA arm. Scans were performed using a 64-slice multidetector CT scanner. All 15 coronary segments were evaluated subjectively for image quality using a 5-point visual scale. Dose-length product was recorded for each patient and the effective radiation dose was calculated
  
  
  RESULTS
  The PG CCTA technique demonstrated a significantly higher incidence of step artifacts in the middle and distal right coronary artery, the distal left anterior descending artery, the second diagonal, the distal left circumflex artery, and the second marginal branches. Nevertheless, the diagnostic performance of these scans was not adversely affected. The mean effective radiation doses were 3.8 +/- 0.9 mSv vs.17.2 +/- 3 mSv for PG CCTA and RG CCTA, respectively (P < 0.0001).
  
  
  CONCLUSIONS
  Artifacts caused by the PG CCTA technique (64 MDCT) scanners tended to appear in specific coronary segments but did not impair the overall diagnostic quality of CCTA and there was a marked reduction in radiation exposure. We conclude that 64-slice PG CCTA is suitable for clinical use, especially for acute chest pain "fast track" evaluation targeted at relatively young subjects in a chest pain unit.
authors.affiliation: Department of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. Orly.Goitein@sheba.health.gov.il
authors.forename: Orly
authors.initials: O
authors.lastname: Goitein
authors.forename: Roy
authors.initials: R
authors.lastname: Beigel
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: Rafael
authors.initials: R
authors.lastname: Kuperstein
authors.forename: Sella
authors.initials: S
authors.lastname: Brosh
authors.forename: Yael
authors.initials: Y
authors.lastname: Eshet
authors.forename: Elio
authors.initials: E
authors.lastname: Di Segni
authors.forename: Eli
authors.initials: E
authors.lastname: Konen
mesh_terms: D016477:Artifacts; D016022:Case-Control Studies; D002637:Chest Pain / Q000209:etiology; D015331:Cohort Studies; D003287:Contrast Media; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis; D005260:Female; D006801:Humans; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed
chemical_list: D003287:Contrast Media; D007479:Iopamidol