title: Sequential SPECT/CT imaging for detection of coronary artery disease in a large cohort: evaluation of the need for additional imaging and radiation exposure.
abstract: Performing both single photon emission computerized tomography (SPECT) and coronary computed tomography angiography (CCTA) in patients suspected for coronary artery disease (CAD) leads to increased radiation exposure. We evaluated the need for additional imaging and following implications for radiation exposure of a sequential SPECT/computed tomography (CT) algorithm.
  
  
  
  5018 consecutive patients without history of CAD were referred for stress-first SPECT and coronary artery calcium (CAC) scoring. If stress SPECT was abnormal, additional rest SPECT and, if feasible, CCTA were acquired. Stress SPECT was normal in 2617 patients (52%). CCTA was not performed in 1289 of the 2401 patients referred for additional imaging (54%), mainly because of severe CAC (47%) or fast/irregular heart rate (22%). 642 patients with abnormal SPECT underwent CCTA, which excluded significant CAD in 378 patients (59%). Mean radiation dose was 4.5 ± 0.3 mSv for stress-only imaging and 13.2 ± 3.3 mSv for additional imaging (P < 0.001).
  
  
  
  Half of the patients do not require additional imaging in our sequential SPECT/CT algorithm, which is accompanied with low radiation exposure. CCTA cannot be performed in half of the patients who undergo additional imaging because of (relative) contra-indications. CCTA is able to correct for false-positive SPECT findings in our algorithm.
authors.affiliation: Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. elsemiekengbers@gmail.com.|Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. elsemiekengbers@gmail.com.
authors.forename: Elsemiek M
authors.initials: EM
authors.lastname: Engbers
authors.affiliation: Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands. v.r.c.derks@isala.nl.
authors.forename: Jorik R
authors.initials: JR
authors.lastname: Timmer
authors.affiliation: Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Jan Paul
authors.initials: JP
authors.lastname: Ottervanger
authors.affiliation: Department of Cardiology, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.|Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mouden
authors.affiliation: Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Ad H J
authors.initials: AHJ
authors.lastname: Oostdijk
authors.affiliation: Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Siert
authors.initials: S
authors.lastname: Knollema
authors.affiliation: Department of Nuclear Medicine, Isala, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands.
authors.forename: Pieter L
authors.initials: PL
authors.lastname: Jager
mesh_terms: D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D008875:Middle Aged; D020380:Needs Assessment; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D000069079:Radiation Exposure / Q000517:prevention & control* / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012307:Risk Factors; D000072098:Single Photon Emission Computed Tomography Computed Tomography / Q000706:statistics & numerical data*; D013382:Subtraction Technique / Q000706:statistics & numerical data; D014600:Utilization Review
keywords: Single photon emission computed tomography; coronary artery calcium score; coronary computed tomography angiography; sequential imaging; suspected coronary artery disease