title: Triple rule-out CT angiography protocol with restricting field of view for detection of pulmonary thromboembolism and aortic dissection in emergency department patients: simulation of modified CT protocol for reducing radiation dose.
abstract: Background Triple rule-out computed tomography (TRO CT) is a CT protocol designed to simultaneously evaluate the coronary, aorta, and pulmonary arteries. Purpose To evaluate potential diagnostic performance of TRO CT with restricted volume coverage for detection of pulmonary thromboembolism (PTE) and aortic dissection (AD). Material and Methods This study included 1224 consecutive patients with acute chest pain who visited the emergency department and underwent TRO CT using a 128-slice dual-source CT. Image data were reconstructed according to the display field of view (DFOV) of coronary CT angiography (CCTA) and TRO CT protocols in each patient. The presence of PTE and AD was evaluated by independent observers in each DFOV. The radiation dose was calculated to evaluate the potential benefits by restricting z-axis coverage to cardiac scan range instead of the whole thorax. Results Among all patients, 22 cases with PTE (1.9%) and nine cases with AD (0.8%) were found. Except for one PTE case, all cases were detected on both DFOV of TRO CT and CCTA. Mean effective dose for evaluation of entire thorax and cardiac scan coverage were 5.9 ± 1.1 mSv and 3.5 ± 0.7 mSv, respectively. Conclusion Isolated PTE and AD outside the CCTA DFOV rarely occur. Therefore, modified TRO CT protocol using cardiac scan coverage can be adopted to detect PTE and AD with reduced radiation dose.
authors.affiliation: 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hyun Su
authors.initials: HS
authors.lastname: Kim
authors.affiliation: 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.|2 Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Sung Mok
authors.initials: SM
authors.lastname: Kim
authors.affiliation: 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Min Jae
authors.initials: MJ
authors.lastname: Cha
authors.affiliation: 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Yoo Na
authors.initials: YN
authors.lastname: Kim
authors.affiliation: 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Hae Jin
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: 2 Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea.|3 Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jin-Ho
authors.initials: JH
authors.lastname: Choi
authors.affiliation: 1 Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.|2 Cardiovascular Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Yeon Hyeon
authors.initials: YH
authors.lastname: Choe
mesh_terms: D000784:Aortic Dissection / Q000150:complications; D001011:Aorta / Q000000981:diagnostic imaging; D001014:Aortic Aneurysm / Q000150:complications / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011655:Pulmonary Embolism / Q000150:complications / Q000000981:diagnostic imaging*; D011829:Radiation Dosage; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012189:Retrospective Studies
keywords: Multidetector computed tomography (MDCT); aortic dissection; coronary artery disease; pulmonary thromboembolism; radiation dose