Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy in daily practice in 2017 (PROTECTION VI)

Thomas J. Stocker, Simon Deseive, Jonathon Leipsic, Martin Hadamitzky, Marcus Y. Chen, Ronen Rubinshtein, Mathias Heckner, Jeroen J. Bax, Xiang Ming Fang, Erik Lerkevang Grove, John Lesser, Pál Maurovich-Horvat, James Otton, Sanghoon Shin, Gianluca Pontone, Hugo Marques, Benjamin Chow, Cesar H. Nomura, Ramzi Tabbalat, Axel Schmermund & 100 others Joon Won Kang, Christopher Naoum, Melany Atkins, Eugenio Martuscelli, Steffen Massberg, Jörg Hausleiter, PROTECTION VI investigator, Patricia Carrascosa, Alejandro Deviggiano, John Magnussen, Anthony Kaplan, Gudrun Feuchtner, Fabian Plank, Kristof De Smet, Nico Buls, Roberto Caldeira Cury, Marcio Sommer Bittencourt, Roberto Nery Dantas, Philipp Blanke, Carl Chartrand-Lefebvre, Anne Chin, Gary Small, F. Claudio Silva, Z. Marcelo Godoy, Wang Jie, Alberto Cadena, Theodor Adla, Vojtech Suchanek, Kamilla Bech Pedersen, Jess Lambrechtsen, Mirza Husic, Juhani Knuuti, Teemu Maaniitty, Bernhard Bischoff, Elisabeth Arnoldi, Joachim Eckert, Tom Finck, Michaela Hell, Mohamed Marwan, Fabian Bamberg, Stefanie Mangold, Thomas Schlosser, Johannes Ludwig, Maria Mylona, Spyros Skiadopoulos, Bálint Szilveszter, Uday Jadav, Brian V. Pinto, Essam Hussein, Daniele Andreini, Massimiliano Sperandio, Kakuya Kitagawa, Naoki Nagasawa, Rami A. Farhan, Lilia M. Sierra Galán, Leovigildo A. Delgado, Marco A. Reza Orozco, Francisco C. Castellón, Mariana D. Zamudio, Andres Preciado-Anaya, Rafael P. Gómez, Signe Helene Forsdahl, Grete Anita Hansen, Anne Günther, Joanna F. Kristiansen, Edith Chavez Huapalla, Percy Teran Chavez, Pedro De A Goncalves, Subramaniyan Ramanathan, Valentin Sinitsyn, Maria Glazkova, Rami Abazid, Osama A. Smettei, Ahmed Dawood, Salama Hussain Omar, Dong Hyun Yang, Tae Hoon Kim, Chul Hwan Park, Seok Jong Ryu, Jose R. Palomares, Hug Cuellar, Alexander Van Rosendael, Michelle C. Williams, David Newby, Edwin J.R. Van Beek, Russell Bull, Kavin Jayawardhana, Patricia Dickson, Jennifer Espey, B. Kelly Han, Renee Bullock-Palmer, Mark Rabbat, Nancy Schoenecker, Dustin M. Thomas, Rosco S. Gore, Sujata M. Shanbhag, John Mahmarian, Jeannie Yu, Todd C. Villines, Binh Nguyen

Research output: Contribution to journalArticleResearchpeer-review

Abstract

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.

LanguageEnglish
Pages3715-3723
Number of pages9
JournalEuropean Heart Journal
Volume39
Issue number41
DOIs
Publication statusPublished - 1 Nov 2018

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Registries
Tomography
Radiation
Computer-Assisted Image Processing
Radiation Exposure
Computed Tomography Angiography
Coronary Artery Disease
Linear Models
Heart Rate
Body Weight
Regression Analysis
Surveys and Questionnaires

Cite this

Stocker, Thomas J. ; Deseive, Simon ; Leipsic, Jonathon ; Hadamitzky, Martin ; Chen, Marcus Y. ; Rubinshtein, Ronen ; Heckner, Mathias ; Bax, Jeroen J. ; Fang, Xiang Ming ; Grove, Erik Lerkevang ; Lesser, John ; Maurovich-Horvat, Pál ; Otton, James ; Shin, Sanghoon ; Pontone, Gianluca ; Marques, Hugo ; Chow, Benjamin ; Nomura, Cesar H. ; Tabbalat, Ramzi ; Schmermund, Axel ; Kang, Joon Won ; Naoum, Christopher ; Atkins, Melany ; Martuscelli, Eugenio ; Massberg, Steffen ; Hausleiter, Jörg ; PROTECTION VI investigator. / Reduction in radiation exposure in cardiovascular computed tomography imaging : results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy in daily practice in 2017 (PROTECTION VI). In: European Heart Journal. 2018 ; Vol. 39, No. 41. pp. 3715-3723.
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title = "Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy in daily practice in 2017 (PROTECTION VI)",
abstract = "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.",
keywords = "Cardiac CT angiography, Dose-length product, Dose-saving strategies, Radiation dose exposure",
author = "Stocker, {Thomas J.} and Simon Deseive and Jonathon Leipsic and Martin Hadamitzky and Chen, {Marcus Y.} and Ronen Rubinshtein and Mathias Heckner and Bax, {Jeroen J.} and Fang, {Xiang Ming} and Grove, {Erik Lerkevang} and John Lesser and P{\'a}l Maurovich-Horvat and James Otton and Sanghoon Shin and Gianluca Pontone and Hugo Marques and Benjamin Chow and Nomura, {Cesar H.} and Ramzi Tabbalat and Axel Schmermund and Kang, {Joon Won} and Christopher Naoum and Melany Atkins and Eugenio Martuscelli and Steffen Massberg and J{\"o}rg Hausleiter and {PROTECTION VI investigator} and Patricia Carrascosa and Alejandro Deviggiano and John Magnussen and Anthony Kaplan and Gudrun Feuchtner and Fabian Plank and {De Smet}, Kristof and Nico Buls and Cury, {Roberto Caldeira} and Bittencourt, {Marcio Sommer} and Dantas, {Roberto Nery} and Philipp Blanke and Carl Chartrand-Lefebvre and Anne Chin and Gary Small and {Claudio Silva}, F. and {Marcelo Godoy}, Z. and Wang Jie and Alberto Cadena and Theodor Adla and Vojtech Suchanek and Pedersen, {Kamilla Bech} and Jess Lambrechtsen and Mirza Husic and Juhani Knuuti and Teemu Maaniitty and Bernhard Bischoff and Elisabeth Arnoldi and Joachim Eckert and Tom Finck and Michaela Hell and Mohamed Marwan and Fabian Bamberg and Stefanie Mangold and Thomas Schlosser and Johannes Ludwig and Maria Mylona and Spyros Skiadopoulos and B{\'a}lint Szilveszter and Uday Jadav and Pinto, {Brian V.} and Essam Hussein and Daniele Andreini and Massimiliano Sperandio and Kakuya Kitagawa and Naoki Nagasawa and Farhan, {Rami A.} and {Sierra Gal{\'a}n}, {Lilia M.} and Delgado, {Leovigildo A.} and {Reza Orozco}, {Marco A.} and Castell{\'o}n, {Francisco C.} and Zamudio, {Mariana D.} and Andres Preciado-Anaya and G{\'o}mez, {Rafael P.} and Forsdahl, {Signe Helene} and Hansen, {Grete Anita} and Anne G{\"u}nther and Kristiansen, {Joanna F.} and Huapalla, {Edith Chavez} and Chavez, {Percy Teran} and {De A Goncalves}, Pedro and Subramaniyan Ramanathan and Valentin Sinitsyn and Maria Glazkova and Rami Abazid and Smettei, {Osama A.} and Ahmed Dawood and Omar, {Salama Hussain} and Yang, {Dong Hyun} and Kim, {Tae Hoon} and Park, {Chul Hwan} and Ryu, {Seok Jong} and Palomares, {Jose R.} and Hug Cuellar and {Van Rosendael}, Alexander and Williams, {Michelle C.} and David Newby and {Van Beek}, {Edwin J.R.} and Russell Bull and Kavin Jayawardhana and Patricia Dickson and Jennifer Espey and Han, {B. Kelly} and Renee Bullock-Palmer and Mark Rabbat and Nancy Schoenecker and Thomas, {Dustin M.} and Gore, {Rosco S.} and Shanbhag, {Sujata M.} and John Mahmarian and Jeannie Yu and Villines, {Todd C.} and Binh Nguyen",
year = "2018",
month = "11",
day = "1",
doi = "10.1093/eurheartj/ehy546",
language = "English",
volume = "39",
pages = "3715--3723",
journal = "European Heart Journal",
issn = "0195-668X",
publisher = "OXFORD UNIV PRESS INC",
number = "41",

}

Stocker, TJ, Deseive, S, Leipsic, J, Hadamitzky, M, Chen, MY, Rubinshtein, R, Heckner, M, Bax, JJ, Fang, XM, Grove, EL, Lesser, J, Maurovich-Horvat, P, Otton, J, Shin, S, Pontone, G, Marques, H, Chow, B, Nomura, CH, Tabbalat, R, Schmermund, A, Kang, JW, Naoum, C, Atkins, M, Martuscelli, E, Massberg, S, Hausleiter, J & PROTECTION VI investigator 2018, 'Reduction in radiation exposure in cardiovascular computed tomography imaging: results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy in daily practice in 2017 (PROTECTION VI)' European Heart Journal, vol. 39, no. 41, pp. 3715-3723. https://doi.org/10.1093/eurheartj/ehy546

Reduction in radiation exposure in cardiovascular computed tomography imaging : results from the PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy in daily practice in 2017 (PROTECTION VI). / Stocker, Thomas J.; Deseive, Simon; Leipsic, Jonathon; Hadamitzky, Martin; Chen, Marcus Y.; Rubinshtein, Ronen; Heckner, Mathias; Bax, Jeroen J.; Fang, Xiang Ming; Grove, Erik Lerkevang; Lesser, John; Maurovich-Horvat, Pál; Otton, James; Shin, Sanghoon; Pontone, Gianluca; Marques, Hugo; Chow, Benjamin; Nomura, Cesar H.; Tabbalat, Ramzi; Schmermund, Axel; Kang, Joon Won; Naoum, Christopher; Atkins, Melany; Martuscelli, Eugenio; Massberg, Steffen; Hausleiter, Jörg; PROTECTION VI investigator.

In: European Heart Journal, Vol. 39, No. 41, 01.11.2018, p. 3715-3723.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Reduction in radiation exposure in cardiovascular computed tomography imaging

T2 - European Heart Journal

AU - Stocker,Thomas J.

AU - Deseive,Simon

AU - Leipsic,Jonathon

AU - Hadamitzky,Martin

AU - Chen,Marcus Y.

AU - Rubinshtein,Ronen

AU - Heckner,Mathias

AU - Bax,Jeroen J.

AU - Fang,Xiang Ming

AU - Grove,Erik Lerkevang

AU - Lesser,John

AU - Maurovich-Horvat,Pál

AU - Otton,James

AU - Shin,Sanghoon

AU - Pontone,Gianluca

AU - Marques,Hugo

AU - Chow,Benjamin

AU - Nomura,Cesar H.

AU - Tabbalat,Ramzi

AU - Schmermund,Axel

AU - Kang,Joon Won

AU - Naoum,Christopher

AU - Atkins,Melany

AU - Martuscelli,Eugenio

AU - Massberg,Steffen

AU - Hausleiter,Jörg

AU - PROTECTION VI investigator

AU - Carrascosa,Patricia

AU - Deviggiano,Alejandro

AU - Magnussen,John

AU - Kaplan,Anthony

AU - Feuchtner,Gudrun

AU - Plank,Fabian

AU - De Smet,Kristof

AU - Buls,Nico

AU - Cury,Roberto Caldeira

AU - Bittencourt,Marcio Sommer

AU - Dantas,Roberto Nery

AU - Blanke,Philipp

AU - Chartrand-Lefebvre,Carl

AU - Chin,Anne

AU - Small,Gary

AU - Claudio Silva,F.

AU - Marcelo Godoy,Z.

AU - Jie,Wang

AU - Cadena,Alberto

AU - Adla,Theodor

AU - Suchanek,Vojtech

AU - Pedersen,Kamilla Bech

AU - Lambrechtsen,Jess

AU - Husic,Mirza

AU - Knuuti,Juhani

AU - Maaniitty,Teemu

AU - Bischoff,Bernhard

AU - Arnoldi,Elisabeth

AU - Eckert,Joachim

AU - Finck,Tom

AU - Hell,Michaela

AU - Marwan,Mohamed

AU - Bamberg,Fabian

AU - Mangold,Stefanie

AU - Schlosser,Thomas

AU - Ludwig,Johannes

AU - Mylona,Maria

AU - Skiadopoulos,Spyros

AU - Szilveszter,Bálint

AU - Jadav,Uday

AU - Pinto,Brian V.

AU - Hussein,Essam

AU - Andreini,Daniele

AU - Sperandio,Massimiliano

AU - Kitagawa,Kakuya

AU - Nagasawa,Naoki

AU - Farhan,Rami A.

AU - Sierra Galán,Lilia M.

AU - Delgado,Leovigildo A.

AU - Reza Orozco,Marco A.

AU - Castellón,Francisco C.

AU - Zamudio,Mariana D.

AU - Preciado-Anaya,Andres

AU - Gómez,Rafael P.

AU - Forsdahl,Signe Helene

AU - Hansen,Grete Anita

AU - Günther,Anne

AU - Kristiansen,Joanna F.

AU - Huapalla,Edith Chavez

AU - Chavez,Percy Teran

AU - De A Goncalves,Pedro

AU - Ramanathan,Subramaniyan

AU - Sinitsyn,Valentin

AU - Glazkova,Maria

AU - Abazid,Rami

AU - Smettei,Osama A.

AU - Dawood,Ahmed

AU - Omar,Salama Hussain

AU - Yang,Dong Hyun

AU - Kim,Tae Hoon

AU - Park,Chul Hwan

AU - Ryu,Seok Jong

AU - Palomares,Jose R.

AU - Cuellar,Hug

AU - Van Rosendael,Alexander

AU - Williams,Michelle C.

AU - Newby,David

AU - Van Beek,Edwin J.R.

AU - Bull,Russell

AU - Jayawardhana,Kavin

AU - Dickson,Patricia

AU - Espey,Jennifer

AU - Han,B. Kelly

AU - Bullock-Palmer,Renee

AU - Rabbat,Mark

AU - Schoenecker,Nancy

AU - Thomas,Dustin M.

AU - Gore,Rosco S.

AU - Shanbhag,Sujata M.

AU - Mahmarian,John

AU - Yu,Jeannie

AU - Villines,Todd C.

AU - Nguyen,Binh

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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.

AB - 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.

KW - Cardiac CT angiography

KW - Dose-length product

KW - Dose-saving strategies

KW - Radiation dose exposure

UR - http://www.scopus.com/inward/record.url?scp=85055827031&partnerID=8YFLogxK

U2 - 10.1093/eurheartj/ehy546

DO - 10.1093/eurheartj/ehy546

M3 - Article

VL - 39

SP - 3715

EP - 3723

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 41

ER -