title: CT angiography of the aorta using 80 kVp in combination with sinogram-affirmed iterative reconstruction and automated tube current modulation: Effects on image quality and radiation dose.
abstract: BACKGROUND
  The objective of this study was to evaluate image quality and radiation dose of a CT angiography (CTA) protocol using 80 kVp in combination with iterative reconstruction and automated tube current modulation.
  
  
  METHODS
  Ninety-five aortic CTA examinations were included in this study. A novel 80 kVp aortic CTA-protocol with iterative reconstruction was introduced in our department in March 2012 for patients with a body mass index (BMI) below 32 kg/m(2). The first 72 consecutive examinations were retrospectively assigned to group A (56 patients, 42 men, 14 women, mean age 69.6 ± 10.7 years, BMI range 19.7-31.1 kg/m(2)). For comparison, the last 23 consecutive examinations performed with the old protocol (100 kVp) were assigned to group B (21 patients, 13 men, 8 women, mean age 67.4 ± 11.1 years, BMI range 19.7-31.9 kg/m(2)). Thoracic and abdominal contrast-to-noise ratio (CNR), signal-to-noise ratio (SNR) and aortic attenuation were assessed. Subjective image quality was rated on a 5-point scale (1 = non diagnostic; 5 = excellent). Furthermore, dose length product (DLP) and volumetric computed tomography dose index (CTDIvol) were analysed.
  
  
  RESULTS
  All examinations achieved diagnostic image quality. Attenuation of the aorta was significantly higher in group A compared with B (thoracic: 443.5 ± 90.5 Hounsfield units (HU) vs. 296.0 ± 61.0 HU; abdominal: 426.3 ± 94.2 HU vs. 283.6 ± 60.5 HU; P < 0.05, respectively). CNR, SNR and subjective image quality were comparable between both groups (CNR: 12.8 ± 3.7 vs. 13.0 ± 7.4; SNR 14.4 ± 3.9 vs. 14.9 ± 8.2; subjective image quality: 4.3 ± 0.6 vs. 4.5 ± 0.6; P > 0.05, respectively). CTDIvol and DLP were significantly lower in group A (1.9 ± 0.5 mGy; 139.2 ± 41.1 mGy × cm) as compared with group B (4.2 ± 1.4 mGy; 292.1 ± 91.5 mGy × cm; P < 0.001, respectively).
  
  
  CONCLUSIONS
  Low-dose CTA of the aorta using 80 kVp with iterative reconstruction enables a significant dose reduction of up to 50% compared with a 100 kVp protocol in patients with a BMI below 32 kg/m(2) while diagnostic image quality is maintained.
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Boos
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Joel
authors.initials: J
authors.lastname: Aissa
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Rotem S
authors.initials: RS
authors.lastname: Lanzman
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Heusch
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Lars
authors.initials: L
authors.lastname: Schimmöller
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schleich
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Thomas
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Gerald
authors.initials: G
authors.lastname: Antoch
authors.affiliation: Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany.
authors.forename: Patric
authors.initials: P
authors.lastname: Kröpil
mesh_terms: D000368:Aged; D000465:Algorithms; D001018:Aortic Diseases / Q000000981:diagnostic imaging*; D001027:Aortography / Q000295:instrumentation / Q000379:methods*; D000072226:Computed Tomography Angiography / Q000295:instrumentation / Q000379:methods*; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: aorta; computed tomography; diagnostic imaging; radiation dose; vascular