Application of Low Tube Potentials in CCTA: Results From the PROTECTION VI Study

Research output: Contribution to journalArticle

Thomas J. Stocker, Jonathon Leipsic, Martin Hadamitzky, Marcus Y. Chen, Ronen Rubinshtein, Simon Deseive, Mathias Heckner, Jeroen J. Bax, Kakuya Kitagawa, Hugo Marques, Axel Schmermund, Claudio Silva, John J. Mahmarian, Joon Won Kang, Erik L. Grove, John Lesser, Steffen Massberg, Jörg Hausleiter

Objectives: The aim of this study was to assess the use of low tube potentials for coronary computed tomography angiography (CCTA) in worldwide clinical practice and its influence on radiation exposure, contrast agent volume, and image quality. Background: CCTA is frequently used in clinical practice. Lowering of tube potential is a potent method to reduce radiation exposure and to economize contrast agent volume. Methods: CCTAs of 4,006 patients from 61 international study sites were analyzed regarding very-low (≤80 kVp), low (90 to 100 kVp), conventional (110 to 120 kVp), and high (≥130 kVp) tube potentials. The impact on dose-length product (DLP) and contrast agent volume was analyzed. Image quality was determined by evaluation of the diagnostic applicability and assessment of the objective image parameters signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR). Results: When compared with conventional tube potentials, low tube potentials were used in 56% of CCTAs (≤80 kVp: 9%; 90 to 100 kVp: 47%), which varied among sites from 0% to 100%. Tube potential reduction was associated with low–cardiovascular risk profile, low body mass index (BMI), and new-generation scanners. Median radiation exposure was lowered by 68% or 50% and median contrast agent volume by 25% or 13% for tube potential protocols of ≤80 kVp or 90 to 100 kVp when compared with conventional tube potentials, respectively (all p < 0.001). With the use of lower tube potentials, the frequency of diagnostic scans was maintained (p = 0.41), whereas SNR and CNR significantly improved (both p < 0.001). Considering BMI eligibility criteria, 58% (n = 946) of conventionally scanned patients would have been suitable for low tube potential protocols, and 44% (n = 831) of patients scanned with 90 to 100 kVp would have been eligible for very-low tube potential CCTA imaging of ≤80 kVp. Conclusions: This large international registry confirms the feasibility of tube potential reduction in clinical practice leading to lower radiation exposure and lower contrast volumes. The current registry also demonstrates that this strategy is still underused in daily practice. (PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 [PROTECTION-VI]; NCT02996903)

Original languageEnglish (US)
Pages (from-to)425-434
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume13
Issue number2
DOIs
StatePublished - Feb 1 2020

PMID: 31202772

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Application of Low Tube Potentials in CCTA : Results From the PROTECTION VI Study. / Stocker, Thomas J.; Leipsic, Jonathon; Hadamitzky, Martin; Chen, Marcus Y.; Rubinshtein, Ronen; Deseive, Simon; Heckner, Mathias; Bax, Jeroen J.; Kitagawa, Kakuya; Marques, Hugo; Schmermund, Axel; Silva, Claudio; Mahmarian, John J.; Kang, Joon Won; Grove, Erik L.; Lesser, John; Massberg, Steffen; Hausleiter, Jörg.

In: JACC: Cardiovascular Imaging, Vol. 13, No. 2, 01.02.2020, p. 425-434.

Research output: Contribution to journalArticle

Harvard

Stocker, TJ, Leipsic, J, Hadamitzky, M, Chen, MY, Rubinshtein, R, Deseive, S, Heckner, M, Bax, JJ, Kitagawa, K, Marques, H, Schmermund, A, Silva, C, Mahmarian, JJ, Kang, JW, Grove, EL, Lesser, J, Massberg, S & Hausleiter, J 2020, 'Application of Low Tube Potentials in CCTA: Results From the PROTECTION VI Study' JACC: Cardiovascular Imaging, vol. 13, no. 2, pp. 425-434. https://doi.org/10.1016/j.jcmg.2019.03.030

APA

Stocker, T. J., Leipsic, J., Hadamitzky, M., Chen, M. Y., Rubinshtein, R., Deseive, S., ... Hausleiter, J. (2020). Application of Low Tube Potentials in CCTA: Results From the PROTECTION VI Study. JACC: Cardiovascular Imaging, 13(2), 425-434. https://doi.org/10.1016/j.jcmg.2019.03.030

Vancouver

Stocker TJ, Leipsic J, Hadamitzky M, Chen MY, Rubinshtein R, Deseive S et al. Application of Low Tube Potentials in CCTA: Results From the PROTECTION VI Study. JACC: Cardiovascular Imaging. 2020 Feb 1;13(2):425-434. https://doi.org/10.1016/j.jcmg.2019.03.030

Author

Stocker, Thomas J. ; Leipsic, Jonathon ; Hadamitzky, Martin ; Chen, Marcus Y. ; Rubinshtein, Ronen ; Deseive, Simon ; Heckner, Mathias ; Bax, Jeroen J. ; Kitagawa, Kakuya ; Marques, Hugo ; Schmermund, Axel ; Silva, Claudio ; Mahmarian, John J. ; Kang, Joon Won ; Grove, Erik L. ; Lesser, John ; Massberg, Steffen ; Hausleiter, Jörg. / Application of Low Tube Potentials in CCTA : Results From the PROTECTION VI Study. In: JACC: Cardiovascular Imaging. 2020 ; Vol. 13, No. 2. pp. 425-434.

BibTeX

@article{b5a73a81e37041c18e9fd2008db6c152,
title = "Application of Low Tube Potentials in CCTA: Results From the PROTECTION VI Study",
abstract = "Objectives: The aim of this study was to assess the use of low tube potentials for coronary computed tomography angiography (CCTA) in worldwide clinical practice and its influence on radiation exposure, contrast agent volume, and image quality. Background: CCTA is frequently used in clinical practice. Lowering of tube potential is a potent method to reduce radiation exposure and to economize contrast agent volume. Methods: CCTAs of 4,006 patients from 61 international study sites were analyzed regarding very-low (≤80 kVp), low (90 to 100 kVp), conventional (110 to 120 kVp), and high (≥130 kVp) tube potentials. The impact on dose-length product (DLP) and contrast agent volume was analyzed. Image quality was determined by evaluation of the diagnostic applicability and assessment of the objective image parameters signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR). Results: When compared with conventional tube potentials, low tube potentials were used in 56{\%} of CCTAs (≤80 kVp: 9{\%}; 90 to 100 kVp: 47{\%}), which varied among sites from 0{\%} to 100{\%}. Tube potential reduction was associated with low–cardiovascular risk profile, low body mass index (BMI), and new-generation scanners. Median radiation exposure was lowered by 68{\%} or 50{\%} and median contrast agent volume by 25{\%} or 13{\%} for tube potential protocols of ≤80 kVp or 90 to 100 kVp when compared with conventional tube potentials, respectively (all p < 0.001). With the use of lower tube potentials, the frequency of diagnostic scans was maintained (p = 0.41), whereas SNR and CNR significantly improved (both p < 0.001). Considering BMI eligibility criteria, 58{\%} (n = 946) of conventionally scanned patients would have been suitable for low tube potential protocols, and 44{\%} (n = 831) of patients scanned with 90 to 100 kVp would have been eligible for very-low tube potential CCTA imaging of ≤80 kVp. Conclusions: This large international registry confirms the feasibility of tube potential reduction in clinical practice leading to lower radiation exposure and lower contrast volumes. The current registry also demonstrates that this strategy is still underused in daily practice. (PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 [PROTECTION-VI]; NCT02996903)",
keywords = "cardiac imaging, coronary computed tomography angiography, dose-saving strategies, radiation dose, tube potential",
author = "Stocker, {Thomas J.} and Jonathon Leipsic and Martin Hadamitzky and Chen, {Marcus Y.} and Ronen Rubinshtein and Simon Deseive and Mathias Heckner and Bax, {Jeroen J.} and Kakuya Kitagawa and Hugo Marques and Axel Schmermund and Claudio Silva and Mahmarian, {John J.} and Kang, {Joon Won} and Grove, {Erik L.} and John Lesser and Steffen Massberg and J{\"o}rg Hausleiter",
year = "2020",
month = "2",
day = "1",
doi = "10.1016/j.jcmg.2019.03.030",
language = "English (US)",
volume = "13",
pages = "425--434",
journal = "JACC: Cardiovascular Imaging",
issn = "1936-878X",
publisher = "Elsevier",
number = "2",

}

RIS

TY - JOUR

T1 - Application of Low Tube Potentials in CCTA

T2 - JACC: Cardiovascular Imaging

AU - Stocker, Thomas J.

AU - Leipsic, Jonathon

AU - Hadamitzky, Martin

AU - Chen, Marcus Y.

AU - Rubinshtein, Ronen

AU - Deseive, Simon

AU - Heckner, Mathias

AU - Bax, Jeroen J.

AU - Kitagawa, Kakuya

AU - Marques, Hugo

AU - Schmermund, Axel

AU - Silva, Claudio

AU - Mahmarian, John J.

AU - Kang, Joon Won

AU - Grove, Erik L.

AU - Lesser, John

AU - Massberg, Steffen

AU - Hausleiter, Jörg

PY - 2020/2/1

Y1 - 2020/2/1

N2 - Objectives: The aim of this study was to assess the use of low tube potentials for coronary computed tomography angiography (CCTA) in worldwide clinical practice and its influence on radiation exposure, contrast agent volume, and image quality. Background: CCTA is frequently used in clinical practice. Lowering of tube potential is a potent method to reduce radiation exposure and to economize contrast agent volume. Methods: CCTAs of 4,006 patients from 61 international study sites were analyzed regarding very-low (≤80 kVp), low (90 to 100 kVp), conventional (110 to 120 kVp), and high (≥130 kVp) tube potentials. The impact on dose-length product (DLP) and contrast agent volume was analyzed. Image quality was determined by evaluation of the diagnostic applicability and assessment of the objective image parameters signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR). Results: When compared with conventional tube potentials, low tube potentials were used in 56% of CCTAs (≤80 kVp: 9%; 90 to 100 kVp: 47%), which varied among sites from 0% to 100%. Tube potential reduction was associated with low–cardiovascular risk profile, low body mass index (BMI), and new-generation scanners. Median radiation exposure was lowered by 68% or 50% and median contrast agent volume by 25% or 13% for tube potential protocols of ≤80 kVp or 90 to 100 kVp when compared with conventional tube potentials, respectively (all p < 0.001). With the use of lower tube potentials, the frequency of diagnostic scans was maintained (p = 0.41), whereas SNR and CNR significantly improved (both p < 0.001). Considering BMI eligibility criteria, 58% (n = 946) of conventionally scanned patients would have been suitable for low tube potential protocols, and 44% (n = 831) of patients scanned with 90 to 100 kVp would have been eligible for very-low tube potential CCTA imaging of ≤80 kVp. Conclusions: This large international registry confirms the feasibility of tube potential reduction in clinical practice leading to lower radiation exposure and lower contrast volumes. The current registry also demonstrates that this strategy is still underused in daily practice. (PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 [PROTECTION-VI]; NCT02996903)

AB - Objectives: The aim of this study was to assess the use of low tube potentials for coronary computed tomography angiography (CCTA) in worldwide clinical practice and its influence on radiation exposure, contrast agent volume, and image quality. Background: CCTA is frequently used in clinical practice. Lowering of tube potential is a potent method to reduce radiation exposure and to economize contrast agent volume. Methods: CCTAs of 4,006 patients from 61 international study sites were analyzed regarding very-low (≤80 kVp), low (90 to 100 kVp), conventional (110 to 120 kVp), and high (≥130 kVp) tube potentials. The impact on dose-length product (DLP) and contrast agent volume was analyzed. Image quality was determined by evaluation of the diagnostic applicability and assessment of the objective image parameters signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR). Results: When compared with conventional tube potentials, low tube potentials were used in 56% of CCTAs (≤80 kVp: 9%; 90 to 100 kVp: 47%), which varied among sites from 0% to 100%. Tube potential reduction was associated with low–cardiovascular risk profile, low body mass index (BMI), and new-generation scanners. Median radiation exposure was lowered by 68% or 50% and median contrast agent volume by 25% or 13% for tube potential protocols of ≤80 kVp or 90 to 100 kVp when compared with conventional tube potentials, respectively (all p < 0.001). With the use of lower tube potentials, the frequency of diagnostic scans was maintained (p = 0.41), whereas SNR and CNR significantly improved (both p < 0.001). Considering BMI eligibility criteria, 58% (n = 946) of conventionally scanned patients would have been suitable for low tube potential protocols, and 44% (n = 831) of patients scanned with 90 to 100 kVp would have been eligible for very-low tube potential CCTA imaging of ≤80 kVp. Conclusions: This large international registry confirms the feasibility of tube potential reduction in clinical practice leading to lower radiation exposure and lower contrast volumes. The current registry also demonstrates that this strategy is still underused in daily practice. (PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 [PROTECTION-VI]; NCT02996903)

KW - cardiac imaging

KW - coronary computed tomography angiography

KW - dose-saving strategies

KW - radiation dose

KW - tube potential

UR - http://www.scopus.com/inward/record.url?scp=85078179065&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85078179065&partnerID=8YFLogxK

U2 - 10.1016/j.jcmg.2019.03.030

DO - 10.1016/j.jcmg.2019.03.030

M3 - Article

VL - 13

SP - 425

EP - 434

JO - JACC: Cardiovascular Imaging

JF - JACC: Cardiovascular Imaging

SN - 1936-878X

IS - 2

ER -

ID: 60066286