title: Accuracy and Radiation Dose Reduction Using Low-Voltage Computed Tomography Coronary Artery Calcium Scoring With Tin Filtration.
abstract: This study prospectively investigated the accuracy and radiation dose reduction of CT coronary artery calcium scoring (CACS) using a 100 kVp acquisition protocol with tin filtration (Sn100 kVp) compared with the standard 120 kVp acquisition protocol; 70 patients (59% men, 62.1 ± 10.7 years) who underwent a clinically indicated CACS acquisition using the standard 120 kVp protocol on a third-generation dual-source CT system were enrolled. An additional Sn100 kVp CACS scan was performed. Agatston scores and categories, percentile-based risk categorization, and radiation dose estimates were derived from 120 and Sn100 kVp studies and compared. Median Agatston scores from the Sn100 and 120 kVp acquisitions were 38.2 and 41.2, respectively (p <0.0001). Excellent correlation of Agatston scores was found between the 2 acquisitions (r = 0.99, p <0.0001). Although the Agatston scores were systematically lower with Sn100 than with 120 kVp, the comparison of Agatston score categories and percentile-based cardiac risk categories showed excellent agreement (κ = 0.98 and κ = 0.98). Image noise was 26.3 ± 5.7 Hounsfield units in Sn100 kVp and 17.6 ± 4.1 Hounsfield units in 120 kVP scans (p <0.0001). The dose-length product was 14.1 ± 3.7 mGy·cm with Sn100 kVp and 58.5 ± 23.5 mGy·cm with 120 kVp scans (p <0.0001), resulting in a significantly lower effective radiation dose (0.19 ± 0.05 vs 0.82 ± 0.32 mSv, p <0.0001) for Sn100 kVp scans. CACS using a low-voltage tin filtration protocol shows excellent correlation and agreement with the standard method with regard to the Agatston score and subsequent cardiac risk categorization, while achieving a 75% reduction in radiation dose.
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Tesche
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina; Department of Radiological Sciences, Oncology, and Pathology, University of Rome "Sapienza", Rome, Italy.
authors.forename: Carlo N
authors.initials: CN
authors.lastname: De Cecco
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina; Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Rozemarijn
authors.initials: R
authors.lastname: Vliegenthart
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina; Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Moritz H
authors.initials: MH
authors.lastname: Albrecht
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Akos
authors.initials: A
authors.lastname: Varga-Szemes
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Taylor M
authors.initials: TM
authors.lastname: Duguay
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina; Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors.forename: Ullrich
authors.initials: U
authors.lastname: Ebersberger
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Richard R
authors.initials: RR
authors.lastname: Bayer
authors.affiliation: Siemens Healthcare GmbH, Computed Tomography-Research and Development, Forchheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Canstein
authors.affiliation: Siemens Healthcare GmbH, Computed Tomography-Research and Development, Forchheim, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schmidt
authors.affiliation: Siemens Healthcare GmbH, Computed Tomography-Research and Development, Forchheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Allmendinger
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Sheldon E
authors.initials: SE
authors.lastname: Litwin
authors.affiliation: Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Pamela B
authors.initials: PB
authors.lastname: Morris
authors.affiliation: Siemens Healthcare GmbH, Computed Tomography-Research and Development, Forchheim, Germany.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Flohr
authors.affiliation: Department of Cardiology and Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich, Germany.
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
authors.affiliation: Division of Cardiovascular Imaging, Medical University of South Carolina, Charleston, South Carolina; Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina. Electronic address: schoepf@musc.edu.
authors.forename: U Joseph
authors.initials: UJ
authors.lastname: Schoepf
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000000981:diagnostic imaging*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011829:Radiation Dosage; D012680:Sensitivity and Specificity; D014001:Tin; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D014001:Tin