The sub-millisievert era in CTCA: the technical basis of the new radiation dose approach

Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose red...

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Bibliographic Details
Published in:Radiologia medica 2020-11, Vol.125 (11), p.1024-1039
Main Authors: Schicchi, Nicolò, Fogante, Marco, Palumbo, Pierpaolo, Agliata, Giacomo, Esposto Pirani, Paolo, Di Cesare, Ernesto, Giovagnoni, Andrea
Format: Article
Language:English
Subjects:
Angiography
Artificial intelligence
Cardiac Radiology
Cardiovascular disease
Computed tomography
Coronary artery disease
Current modulation
Diagnostic Radiology
Diagnostic systems
Electrocardiography
Evaluation
Heart diseases
Hemodynamics
Imaging
Interventional Radiology
Iterative methods
Medical imaging
Medicine
Medicine & Public Health
Morphology
Neuroradiology
Radiation dosage
Radiology
Reduction
Tomography
Ultrasound
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Summary:Computed tomography coronary angiography (CTCA) has become a cornerstone in the diagnostic process of the heart disease. Although the cardiac imaging with interventional procedures is responsible for approximately 40% of the cumulative effective dose in medical imaging, a relevant radiation dose reduction over the last decade was obtained, with the beginning of the sub-mSv era in CTCA. The main technical basis to obtain a radiation dose reduction in CTCA is the use of a low tube voltage, the adoption of a prospective electrocardiogram-triggering spiral protocol and the application of the tube current modulation with the iterative reconstruction technique. Nevertheless, CTCA examinations are characterized by a wide range of radiation doses between different radiology departments. Moreover, the dose exposure in CTCA is extremely important because the benefit–risk calculus in comparison with other modalities also depends on it. Finally, because anatomical evaluation not adequately predicts the hemodynamic relevance of coronary stenosis, a low radiation dose in routine CTCA would allow the greatest use of the myocardial CT perfusion, fractional flow reserve-CT, dual-energy CT and artificial intelligence, to shift focus from morphological assessment to a comprehensive morphological and functional evaluation of the stenosis. Therefore, the aim of this work is to summarize the correct use of the technical basis in order that CTCA becomes an established examination for assessment of the coronary artery disease with low radiation dose.
ISSN:0033-8362
1826-6983
DOI:10.1007/s11547-020-01280-1