title: Radiation and contrast agent doses reductions by using 80-kV tube voltage in coronary computed tomographic angiography: a comparative study.
abstract: OBJECTIVE
  To investigate the effects of 80-kilovoltage (kV) tube voltage coronary computed tomographic angiography (CCTA) with a reduced amount of contrast agent on qualitative and quantitative image quality parameters and on radiation dose in patients with a body mass index (BMI) <23.0 kg/m(2).
  
  
  METHODS
  One hundred and twenty consecutive patients with a BMI <23.0 kg/m(2) and a low calcium load undergoing retrospective electrocardiogram (ECG)-gated dual-source CCTA were randomized into two groups [standard-tube voltage (120-kV) vs. low-tube voltage (80-kV)]. The injection flow rate of contrast agent (350 mg I/mL) was adjusted to body weight of each patient (4.5-5.5 mL/s in the 120-kV group and 2.8-3.8 mL/s in the 80-kV group). Radiation and contrast agent doses were evaluated. Quantitative image quality parameters and figure of merit (FOM) of coronary artery were evaluated. Each coronary segment was evaluated for image quality on a 4-point scale.
  
  
  RESULTS
  Compared with the 120-kV group, effective dose and amount of contrast agent in the 80-kV group were decreased by 57.8% and 30.5% (effective dose:2.7 ± 0.5 vs. 6.4 ± 1.3 mSv; amount of contrast agent:57.1 ± 3.2 vs. 82.1 ± 6.1 mL; both p<0.0001), respectively. Image noise was 22.7 ± 2.1HU for 120-kV images and 33.2 ± 5.2 HU for 80-kV images (p<0.0001). Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the proximal right coronary artery (RCA) and left main coronary artery (LMA) were all lower in 80-kV than 120-kV images (SNR in the proximal RCA: 16.5 ± 1.8 vs. 19.4 ± 2.8; SNR in the LMA: 16.3 ± 2.0 vs.19.6 ± 2.7; CNR in the proximal RCA: 19.4 ± 2.3 vs.22.9 ± 3.0; CNR in the LMA: 18.8 ± 2.4 vs. 22.7 ± 2.9; all p<0.0001). FOM were all significantly higher in 80-kV than 120-kV images (proximal RCA: 146.7 ± 45.1 vs. 93.4 ± 32.0; LMA: 139.1 ± 47.2 vs. 91.6 ± 31.1; all p<0.0001). There was no significant difference in image quality score between the two groups (3.3 ± 0.8 vs. 3.3 ± 0.8, p=0.068) despite decreased SNR and CNR of coronary artery in the 80-kV group.
  
  
  CONCLUSIONS
  The 80-kV protocol significantly reduces radiation and contrast agent doses in CCTA in patients with a low BMI <23.0 kg/m(2) and a low calcium load while maintaining image quality.
authors: Department of Radiology, Wuhan 161th Hospital, Wuhan, China.
authors: Jian-Xin
authors: JX
authors: Cao
authors: Department of Radiology, Wuhan 161th Hospital, Wuhan, China. Electronic address: wym6669@yahoo.com.cn.
authors: Yi-Min
authors: YM
authors: Wang
authors: Department of Cardiology, Asia Heart Hospital, Wuhan, China.
authors: Jin-Guo
authors: JG
authors: Lu
authors: Department of Radiology, Wuhan 161th Hospital, Wuhan, China.
authors: Yu
authors: Y
authors: Zhang
authors: Department of Radiology, Wuhan 161th Hospital, Wuhan, China.
authors: Peng
authors: P
authors: Wang
authors: Department of Radiology, Wuhan 161th Hospital, Wuhan, China.
authors: Cheng
authors: C
authors: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004305:Dose-Response Relationship, Drug; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D007472:Iohexol / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D007472:Iohexol
keywords: Computed tomography (CT); Contrast agent; Coronary angiography; Image quality; Radiation dose