title: CT dose reduction using prospectively triggered or fast-pitch spiral technique employed in cardiothoracic imaging (the CT dose study).
abstract: OBJECTIVE
  To establish current radiation dose levels with contemporary scanners capable of prospectively triggered or high-pitch spiral scan modes to previous generation scanners among patients evaluated for coronary artery disease, pulmonary embolism, aortic disease, and "triple rule out" in a large population of patients at multiple centers.
  
  
  BACKGROUND
  Previous small-scale studies with carefully controlled scan protocols report that CT scanners that facilitate prospectively triggered scanning and provide high-pitch spiral CT scan modes drastically lower radiation doses. However, diagnostic reference levels should be selected by medical bodies on the basis of large surveys of representative sites and reviewed at appropriate time intervals.
  
  
  METHODS
  Scan data including dose and image quality parameters were collected retrospectively from 64 slice scanners (control) and prospectively after sites installed 128-slice dual-source scanners with high-pitch capability (study). Protocol selection was purposely not specified to survey "real world" results. Blinded quantitative image analysis was performed on every fifth scan.
  
  
  RESULTS
  From April 2011 to March 2012, 2085 patients at 9 sites completed the study: 1051 coronary artery disease (509 control, 542 study), 528 pulmonary embolism (267 control, 261 study), 419 aortic disease (268 control, 151 study), and 87 triple rule out (53 control, 34 study). There was a significant reduction in median dose-length product (DLP) from 669 mGy ∙ cm (interquartile range [IQR]: 419-1026 mGy ∙ cm) in the control group to 260 mGy ∙ cm (IQR: 159-441 mGy ∙ cm) in the study group, a reduction by 61% (P < .0001) and was lower in all categories. No significant differences were noted in image quality.
  
  
  CONCLUSIONS
  Use of advanced scanners facilitating prospectively triggered or high-pitch spiral scan modes results in marked dose reduction across a variety of cardiovascular studies, with no compromise in image quality. These findings may contribute to new target dose recommendations in societal guidelines.
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA. Electronic address: kchinnaiyan@beaumont.edu.
authors.forename: Kavitha M
authors.initials: KM
authors.lastname: Chinnaiyan
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA.
authors.forename: Abhay N
authors.initials: AN
authors.lastname: Bilolikar
authors.affiliation: Department of Radiology, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Walsh
authors.affiliation: Department of Radiology, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Wood
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: DePetris
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA.
authors.forename: Ralph
authors.initials: R
authors.lastname: Gentry
authors.affiliation: Department of Research Administration, William Beaumont Hospitals, 3601 W. 13 Mile Road, Royal Oak, MI, USA.
authors.forename: Judith
authors.initials: J
authors.lastname: Boura
authors.affiliation: Department of Diagnostic Radiology, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Suhny
authors.initials: S
authors.lastname: Abbara
authors.affiliation: Department of Cardiac Imaging, King Abdul-Aziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Mouaz
authors.initials: M
authors.lastname: Al-Mallah
authors.affiliation: Department of Radiology, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA.
authors.forename: Kostaki
authors.initials: K
authors.lastname: Bis
authors.affiliation: Department of Cardiac Imaging, King Abdul-Aziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Boswell
authors.affiliation: Department of Radiology, Naval Medical Center, San Diego, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Gallagher
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, Troy, MI, USA.
authors.forename: Ing-Orn
authors.initials: IO
authors.lastname: Arunakul
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, Troy, MI, USA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Halliburton
authors.affiliation: Division of Radiology, Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Jacobs
authors.affiliation: Department of Radiology, New York University, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Lesser
authors.affiliation: Cardiac Imaging, Minneapolis Heart Institute, Minneapolis, MN, USA.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
authors.affiliation: Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA; Department Radiology, Medical University of South Carolina, Charleston, SC, USA; University of Minnesota, Minneapolis, MN, USA.
authors.forename: Uma S
authors.initials: US
authors.lastname: Valeti
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, 3601 W. 13 Mile Road, Royal Oak, MI, USA.
authors.forename: Gilbert L
authors.initials: GL
authors.lastname: Raff
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011829:Radiation Dosage; D012815:Signal Processing, Computer-Assisted; D014057:Tomography, X-Ray Computed / Q000295:instrumentation / Q000379:methods* / Q000639:trends
keywords: DLP; Dose recommendation; High-pitch; Prospective-triggered; Radiation dose reduction