Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iNdaily practice in 2017 (PROTECTION VI)
Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iNdaily practice in 2017 (PROTECTION VI)
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DOI：
10.1093/eurheartj/ehy546
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发表时间：
2018-11-01
影响因子：
39.3
通讯作者：
Hausleiter, Joerg
中科院分区：
文献类型：
--
作者：
Stocker, Thomas J.;Deseive, Simon;Hausleiter, Joerg
心脏计算机断层扫描血管造影（CTA）的进展已被开发用于减少剂量，但其在临床实践中的有效性在很大程度上是未知的。本研究的目的是评估辐射剂量暴露和利用的剂量节省策略对比增强心脏CTAin daily practice.Methods和结果六十一家医院从32个国家前瞻性地招募了4502例患者在一个日历月在2017年进行心脏CTA。在中心核心实验室分析了计算机断层扫描血管造影扫描数据和图像，并与2007年进行的类似剂量调查进行了比较。进行线性回归分析，以确定与剂量相关的独立预测因子。心脏CTA最常见的适应症是89%患者的冠状动脉疾病评价。冠状动脉CTA的中位剂量长度乘积（DLP）为195 mGy * cm（四分位数范围110 - 338 mGy * cm）。与2007年相比，DLP降低了78%（P <0.001），而非诊断性冠状动脉CTA没有增加（2007年为1.7%，2017年调查为1.9%，P = 0.55）。在具有最低和最高DLP的医院之间观察到中位DLP的37倍变异性（中位DLP范围为57 - 2090 mGy * cm）。冠状动脉CTA的辐射剂量的独立预测因素是：体重，心率，窦性心律，管电压，迭代图像重建，和扫描protocols.Conclusion的选择，这个大的国际辐射剂量调查表明，在过去的十年中，冠状动脉CTA的辐射暴露相当大的减少。然而，辐射照射的大的站点间变化强调了进一步的站点特定的培训和适应当代心脏扫描协议的需要。
Aims Advances of cardiac computed tomography angiography (CTA) have been developed for dose reduction, but their efficacy in clinical practice is largely unknown. This study was designed to evaluate radiation dose exposure and utilization of dose-saving strategies for contrast-enhanced cardiac CTA in daily practice.Methods and results Sixty one hospitals from 32 countries prospectively enrolled 4502 patients undergoing cardiac CTA during one calendar month in 2017. Computed tomography angiography scan data and images were analysed in a central core lab and compared with a similar dose survey performed in 2007. Linear regression analysis was performed to identify independent predictors associated with dose. The most frequent indication for cardiac CTA was the evaluation of coronary artery disease in 89% of patients. The median dose-length product (DLP) of coronary CTA was 195 mGy*cm (interquartile range 110-338 mGy*cm). When compared with 2007, the DLP was reduced by 78% (P < 0.001) without an increase in non-diagnostic coronary CTAs (1.7% in 2007 vs. 1.9% in 2017 surveys, P = 0.55). A 37-fold variability in median DLP was observed between the hospitals with lowest and highest DLP (range of median DLP 57-2090 mGy*cm). Independent predictors for radiation dose of coronary CTA were: body weight, heart rate, sinus rhythm, tube voltage, iterative image reconstruction, and the selection of scan protocols.Conclusion This large international radiation dose survey demonstrates considerable reduction of radiation exposure in coronary CTA during the last decade. However, the large inter-site variability in radiation exposure underlines the need for further site-specific training and adaptation of contemporary cardiac scan protocols.