title: Feasibility and diagnostic accuracy of a low radiation exposure protocol for prospective ECG-triggering coronary MDCT angiography.
abstract: OBJECTIVE
  To compare the feasibility, accuracy, and effective radiation dose (ED) of multidetector computed tomography (MDCT) in the detection of coronary artery disease using a combined ED-saving strategy including prospective electrocardiogram (ECG) triggering with a short x-ray window and a body mass index (BMI)-adapted imaging protocol using adaptive statistical iterative reconstruction (ASIR; group 1), in comparison with a prospective ECG triggering strategy alone (group 2).
  
  
  METHODS
  One hundred and seventy patients scheduled for invasive coronary angiography (ICA) were evaluated. Fourteen patients were not eligible for MDCT. The remaining 156 patients were randomized to group 1 (78 patients) and group 2 (78 patients). Eight and 11 patients in groups 1 and 2, respectively, were excluded after randomization because the patients' heart rates were >65 beats/min. MDCT images were assessed for feasibility, signal-to-noise ration (SNR), and contrast-to-noise ratio (CNR), accuracy in detection of coronary stenoses >50% versus ICA and for ED.
  
  
  RESULTS
  The feasibility, SNR, CNR, accuracy in a segment-based and patient-based model were similar in both groups (97 versus 95%, 14.5 ± 3.9 versus 14.2 ± 4.1, 16 ± 4.6 versus 16.5 ± 4.4, 95 versus 94% and 97 versus 99%, respectively). The ED in group 1 was 72% lower than in group 2 (2.1 ± 1.2 versus 7.5 ± 1.8 mSv, respectively; p<0.01).
  
  
  CONCLUSIONS
  The use of a multi-parametric ED saving protocol results in a significant reduction in ED without a negative impact on accuracy.
authors.affiliation: Centro Cardiologico Monzino, IRCCS, Milan, Italy. gianluca.pontone@ccfm.it
authors.forename: G
authors.initials: G
authors.lastname: Pontone
authors.forename: D
authors.initials: D
authors.lastname: Andreini
authors.forename: A L
authors.initials: AL
authors.lastname: Bartorelli
authors.forename: E
authors.initials: E
authors.lastname: Bertella
authors.forename: S
authors.initials: S
authors.lastname: Mushtaq
authors.forename: C
authors.initials: C
authors.lastname: Foti
authors.forename: A
authors.initials: A
authors.lastname: Formenti
authors.forename: L
authors.initials: L
authors.lastname: Chiappa
authors.forename: A
authors.initials: A
authors.lastname: Annoni
authors.forename: S
authors.initials: S
authors.lastname: Cortinovis
authors.forename: A
authors.initials: A
authors.lastname: Baggiano
authors.forename: E
authors.initials: E
authors.lastname: Conte
authors.forename: F
authors.initials: F
authors.lastname: Bovis
authors.forename: F
authors.initials: F
authors.lastname: Veglia
authors.forename: G
authors.initials: G
authors.lastname: Ballerini
authors.forename: P
authors.initials: P
authors.lastname: Agostoni
authors.forename: C
authors.initials: C
authors.lastname: Fiorentini
authors.forename: M
authors.initials: M
authors.lastname: Pepi
mesh_terms: D000368:Aged; D000465:Algorithms; D015992:Body Mass Index; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted; D012680:Sensitivity and Specificity; D013997:Time Factors