Temporal Trends in Radiation Exposure and Utilization of Coronary CT Angiography, SPECT, and Invasive Coronary Angiography
Ronald L. Jones *
Cardiology Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.
Richard A. Clark
Cardiology Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.
Bernard J. Rubal
Cardiology Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.q
Ryan J. McDonough
Cardiology Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.
Kenneth Stone
Cardiology Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.
Edward A. Hulten
Cardiology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue. Bethesda, MD 20850, USA.
Todd C. Villines
Cardiology Service, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue. Bethesda, MD 20850, USA.
Ahmad M. Slim *
Cardiology Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.
Kevin E. Steel *
Cardiology Service, Brooke Army Medical Center, 3551 Roger Brooke Dr, Fort Sam Houston, TX 78234, USA.
*Author to whom correspondence should be addressed.
Abstract
Background: The use of noninvasive medical imaging has increased over the past decade at a cost of significant lifetime radiation exposure to study subjects. We report the implementation of radiation dose reduction methods and associated reduction in ionizing radiation exposure with Coronary Computed Tomography Angiography (CCTA) over time.
Methods: Radiation doses and total number of studies performed were evaluated constantly from January 2010 to September 2012 for CCTA (N=2613), as well as Single photon emission computed tomography (SPECT, N=8060) part of an ongoing effort to minimize radiation exposure. Analysis of variance was used to evaluate the radiation exposure reduction among modalities. We compared CCTA radiation doses in the era of retrospective protocols coupled with dose modulation (40%-80%phase) using Siemens® 64-slice Dual Source technology, with prospective scanning on the same equipment, as well as radiation doses on the newer Siemens® Flash Equipment and the implementation of nursing/technologist aggressively driven protocol for heart rate control and image acquisition independent of imaging provider presence during acquisition.
Results: The radiation dose reduction with implementation of multiple measures of radiation reduction to include physician independent-technician driven CCTA protocol resulted in a reduction from mean of 9.85±5.96 (median 8.8mSv) to mean of 3.00±2.53(median 2.1mSv) (p<0.0001). CCTA radiation dose has decreased by 69.2% since January of 2010 while SPECT radiation dose remained constant at 14mSv (p<0.0001).
Conclusion: Continued advances in software and hardware technology, combined with “physician independent-technician driven” CCTA protocol have drastically reduced radiation dosing in CCTA to annual background radiation exposure, while maximizing the benefit of the study and without sacrificing patient safety.
Keywords: CCTA, radiation dose reduction, physician independent CCTA, ICA.