title: Ultra low-dose chest ct with iterative reconstructions as an alternative to conventional chest x-ray prior to heart surgery (CRICKET study): Rationale and design of a multicenter randomized trial.
abstract: BACKGROUND
  Stroke after cardiac surgery is a severe complication with a persistently high incidence of 1.4 - 9.7%. Postoperative strokes are mainly embolic and can be provoked by manipulation and clamping of the aorta during cardiac surgery, resulting in the mobilization of atherothrombotic material and calcifications from the aortic wall. Computed tomography (CT) can offer preoperative visualization of aortic calcifications with low radiation exposure. We hypothesize that preoperative knowledge regarding the location and extent of aortic calcifications can be used to optimize surgical strategy and decrease postoperative stroke rate.
  
  
  METHODS
  The CRICKET study (ultra low-dose chest CT with iterative reconstructions as an alternative to conventional chest x-ray prior to heart surgery) is a prospective multicenter randomized clinical trial to evaluate whether non-contrast chest CT before cardiac surgery can decrease postoperative stroke rate by optimizing surgical strategy. Patients scheduled to undergo cardiac surgery aged 18 years and older are eligible for inclusion. Exclusion criteria are pregnancy, a chest/cardiac CT in the past three months, emergency surgery, concomitant or prior participation in a study with ionizing radiation and unwillingness to be informed about incidental findings. Subjects (n = 1.724) are randomized between routine care, including a chest x-ray, or routine care with an additional low dose chest CT. The primary objective is to investigate whether the postoperative in-hospital stroke rate is reduced in the CT arm compared to the routine care arm of the randomized trial. The secondary outcome measures are altered surgical approach based on CT findings and cost-effectiveness.
authors: Department of Radiology, University Medical Center, P.O. Box 85000, 3508GA Utrecht, The Netherlands. Electronic address: a.m.denharder@umcutrecht.nl.
authors: Annemarie M
authors: AM
authors: den Harder
authors: Department of Cardiothoracic Surgery, University Medical Center, P.O. Box 85000, 3508GA Utrecht, The Netherlands.
authors: Linda M
authors: LM
authors: de Heer
authors: MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor ut, Budapest 1122, Hungary.
authors: Pal
authors: P
authors: Maurovich-Horvat
authors: MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, 68 Varosmajor ut, Budapest 1122, Hungary.
authors: Bela
authors: B
authors: Merkely
authors: Department of Radiology, University Medical Center, P.O. Box 85000, 3508GA Utrecht, The Netherlands.
authors: Pim A
authors: PA
authors: de Jong
authors: Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University Medical Center, P.O. Box 5800, 6202AZ Maastricht, The Netherlands.
authors: Marco
authors: M
authors: Das
authors: Department of Epidemiology, Julius Center for Health Sciences and Primary Care, P.O. Box 85000, 3508GA Utrecht, The Netherlands; National Institute of Public Health and the Environment, P.O. Box 1, 3720 BA Bilthoven, The Netherlands.
authors: G Ardine
authors: GA
authors: de Wit
authors: Department of Radiology, University Medical Center, P.O. Box 85000, 3508GA Utrecht, The Netherlands.
authors: Tim
authors: T
authors: Leiner
authors: Department of Radiology, Erasmus Medical Center, P.O. Box 2040, 3000CA Rotterdam, The Netherlands.
authors: Ricardo P J
authors: RP
authors: Budde
mesh_terms: D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics; D001027:Aortography / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000191:economics; D002985:Clinical Protocols; D000072226:Computed Tomography Angiography / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D061330:Multidetector Computed Tomography / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D009426:Netherlands; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000191:economics / Q000379:methods*; D011446:Prospective Studies; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000191:economics / Q000517:prevention & control*; D012107:Research Design; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D061205:Vascular Calcification / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics
keywords: Aortic calcifications; Cardiac surgery; Computed tomography; Postoperative complications; Stroke