A prospective national survey of coronary CT angiography radiation doses in the United Kingdom

• Published in: Journal of cardiovascular computed tomography 2017-07, Vol.11 (4), p.268-273
• Main Authors: Castellano, Isabel A., PhD, Nicol, Edward D., MD MBA, Bull, Russell K., MB BChir, Roobottom, Carl A., MD, Williams, Michelle C., PhD, Harden, Stephen P., MD
• Format: Article
• Language: English
• Subjects: Benchmarking; Body Mass Index; Cardiovascular; Computed Tomography Angiography - adverse effects; Computed Tomography Angiography - standards; Coronary Angiography - adverse effects; Coronary Angiography - methods; Coronary Angiography - standards; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - physiopathology; Coronary CT angiography; Coronary Vessels - diagnostic imaging; Dose-length product; Health Care Surveys; Heart Rate; Hospitals, High-Volume; Hospitals, Low-Volume; Humans; Predictive Value of Tests; Prospective Studies; Quality Improvement; Quality Indicators, Health Care; Radiation Dosage; Radiation dose; Radiation dose survey; Radiation Exposure - adverse effects; Radiation Exposure - standards; Risk Factors; United Kingdom
• ISSN: 1934-5925; 1876-861X
• DOI: 10.1016/j.jcct.2017.05.002

Abstract Background Little real-world radiation dose data exist for the majority of cardiovascular CT. Some data have been published for coronary CT angiography (coronary CTA) specifically, but they invariably arise from high-volume centres with access to the most recent technology. Objective The aim of this study was to document real-world radiation doses for coronary CTA in the United Kingdom, and to establish their relationship to clinical protocol selection, acquisition heart rate, and scanner technology. Methods A dose survey questionnaire was distributed to members of the British Society of Cardiovascular Imaging and other UK cardiac CT units. All participating centres collected data for consecutive coronary CTA cases over one month. The survey captured information about the exam conducted, patient demographics, pre-scan details such as beta-blocker administration, acquisition heart rate and scan technique, and post-scan dose indicators – series volumetric CT dose index (CTDIvol ), series dose-length product (DLP), and exam DLP. Results Fifty centres provided data on a total of 1341 coronary CTA exams. Twenty-nine centres (58%) performed at least 20 coronary CTA scans in the collection period. The median BMI, acquisition heart rate and exam DLP were 28 kg/m2 , 60 bpm and 209 mGycm respectively. The corresponding effective dose was estimated as 5.9 mSv using a conversion factor of 0.028 mSv/mGycm. There was no statistically significant difference in radiation dose between low and high-volume centres. Median exam DLP increased with the acquisition heart rate due to the selection of wider temporal windows. The highest exam DLPs were obtained on the older scanner technology. Conclusion This study provides baseline data for benchmarking practice, optimizing radiation dose and improving service quality locally.