High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction

Georg Apfaltrer; Moritz H. Albrecht; U. Joseph Schoepf; Taylor M. Duguay; Carlo N. De Cecco; John W. Nance; Domenico De Santis; Paul Apfaltrer; Marwen H. Eid; Chelsea D. Eason; Zachary M. Thompson; Maximilian J. Bauer; Akos Varga-Szemes; Brian E. Jacobs; Erich Sorantin; Christian Tesche

doi:10.1007/s00330-017-5249-2

High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction

Georg Apfaltrer, Moritz H. Albrecht, U. Joseph Schoepf, Taylor M. Duguay, Carlo N. De Cecco, John W. Nance, Domenico De Santis, Paul Apfaltrer, Marwen H. Eid, Chelsea D. Eason, Zachary M. Thompson, Maximilian J. Bauer, Akos Varga-Szemes, Brian E. Jacobs, Erich Sorantin, Christian Tesche

Houston Methodist

Research output: Contribution to journal › Article › peer-review

34 Scopus citations

Abstract

Objectives: To investigate diagnostic accuracy and radiation dose of high-pitch CT coronary artery calcium scoring (CACS) with tin filtration (Sn100kVp) versus standard 120kVp high-pitch acquisition. Methods: 78 patients (58% male, 61.5±9.1 years) were prospectively enrolled. Subjects underwent clinical 120kVp high-pitch CACS using third-generation dual-source CT followed by additional high-pitch Sn100kVp acquisition. Agatston scores, calcium volume scores, Agatston score categories, percentile-based risk categorization and radiation metrics were compared. Results: 61/78 patients showed coronary calcifications. Median Agatston scores were 34.9 [0.7–197.1] and 41.7 [0.7–207.2] and calcium volume scores were 34.1 [0.7–218.0] for Sn100kVp and 35.7 [1.1–221.0] for 120kVp acquisitions, respectively (both p<0.0001). Bland-Altman analysis revealed underestimated Agatston scores and calcium volume scores with Sn100kVp versus 120kVp acquisitions (mean difference: 16.4 and 11.5). However, Agatston score categories and percentile-based risk categories showed excellent agreement (ĸ=0.98 and ĸ=0.99). Image noise was 25.8±4.4HU and 16.6±2.9HU in Sn100kVp and 120kVp scans, respectively (p<0.0001). Dose-length-product was 9.9±4.8mGy*cm and 40.9±14.4mGy*cm with Sn100kVp and 120kVp scans, respectively (p<0.0001). This resulted in significant effective radiation dose reduction (0.13±0.07mSv vs. 0.57±0.2mSv, p<0.0001) for Sn100kVp acquisitions. Conclusion: CACS using high-pitch low-voltage tin-filtered acquisitions demonstrates excellent agreement in Agatston score and percentile-based cardiac risk categorization with standard 120kVp high-pitch acquisitions. Furthermore, radiation dose was significantly reduced by 78% while maintaining accurate risk prediction. Key points: • Coronary artery calcium scoring with tin filtration reduces radiation dose by 78%. • There is excellent correlation between high-pitch Sn100kVp and standard 120kVp acquisitions. • Excellent agreement regarding Agatston score categories and percentile-based risk categorization was achieved. • No cardiac risk reclassifications were observed using Sn100kVp coronary artery calcium scoring.

Original language	English (US)
Pages (from-to)	3097-3104
Number of pages	8
Journal	European Radiology
Volume	28
Issue number	7
DOIs	https://doi.org/10.1007/s00330-017-5249-2
State	Published - Jul 1 2018

Keywords

Computed tomography
Coronary artery calcium
High-pitch
Radiation dose
Tin filtration

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

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10.1007/s00330-017-5249-2

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Apfaltrer, G., Albrecht, M. H., Schoepf, U. J., Duguay, T. M., De Cecco, C. N., Nance, J. W., De Santis, D., Apfaltrer, P., Eid, M. H., Eason, C. D., Thompson, Z. M., Bauer, M. J., Varga-Szemes, A., Jacobs, B. E., Sorantin, E., & Tesche, C. (2018). High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction. European Radiology, 28(7), 3097-3104. https://doi.org/10.1007/s00330-017-5249-2

Apfaltrer, G, Albrecht, MH, Schoepf, UJ, Duguay, TM, De Cecco, CN, Nance, JW, De Santis, D, Apfaltrer, P, Eid, MH, Eason, CD, Thompson, ZM, Bauer, MJ, Varga-Szemes, A, Jacobs, BE, Sorantin, E & Tesche, C 2018, 'High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction', European Radiology, vol. 28, no. 7, pp. 3097-3104. https://doi.org/10.1007/s00330-017-5249-2

@article{f6e9cf8831ee4760afbe0230134d57a2,

title = "High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction",

abstract = "Objectives: To investigate diagnostic accuracy and radiation dose of high-pitch CT coronary artery calcium scoring (CACS) with tin filtration (Sn100kVp) versus standard 120kVp high-pitch acquisition. Methods: 78 patients (58% male, 61.5±9.1 years) were prospectively enrolled. Subjects underwent clinical 120kVp high-pitch CACS using third-generation dual-source CT followed by additional high-pitch Sn100kVp acquisition. Agatston scores, calcium volume scores, Agatston score categories, percentile-based risk categorization and radiation metrics were compared. Results: 61/78 patients showed coronary calcifications. Median Agatston scores were 34.9 [0.7–197.1] and 41.7 [0.7–207.2] and calcium volume scores were 34.1 [0.7–218.0] for Sn100kVp and 35.7 [1.1–221.0] for 120kVp acquisitions, respectively (both p<0.0001). Bland-Altman analysis revealed underestimated Agatston scores and calcium volume scores with Sn100kVp versus 120kVp acquisitions (mean difference: 16.4 and 11.5). However, Agatston score categories and percentile-based risk categories showed excellent agreement (ĸ=0.98 and ĸ=0.99). Image noise was 25.8±4.4HU and 16.6±2.9HU in Sn100kVp and 120kVp scans, respectively (p<0.0001). Dose-length-product was 9.9±4.8mGy*cm and 40.9±14.4mGy*cm with Sn100kVp and 120kVp scans, respectively (p<0.0001). This resulted in significant effective radiation dose reduction (0.13±0.07mSv vs. 0.57±0.2mSv, p<0.0001) for Sn100kVp acquisitions. Conclusion: CACS using high-pitch low-voltage tin-filtered acquisitions demonstrates excellent agreement in Agatston score and percentile-based cardiac risk categorization with standard 120kVp high-pitch acquisitions. Furthermore, radiation dose was significantly reduced by 78% while maintaining accurate risk prediction. Key points: • Coronary artery calcium scoring with tin filtration reduces radiation dose by 78%. • There is excellent correlation between high-pitch Sn100kVp and standard 120kVp acquisitions. • Excellent agreement regarding Agatston score categories and percentile-based risk categorization was achieved. • No cardiac risk reclassifications were observed using Sn100kVp coronary artery calcium scoring.",

keywords = "Computed tomography, Coronary artery calcium, High-pitch, Radiation dose, Tin filtration",

author = "Georg Apfaltrer and Albrecht, {Moritz H.} and Schoepf, {U. Joseph} and Duguay, {Taylor M.} and {De Cecco}, {Carlo N.} and Nance, {John W.} and {De Santis}, Domenico and Paul Apfaltrer and Eid, {Marwen H.} and Eason, {Chelsea D.} and Thompson, {Zachary M.} and Bauer, {Maximilian J.} and Akos Varga-Szemes and Jacobs, {Brian E.} and Erich Sorantin and Christian Tesche",

note = "Funding Information: The authors of this manuscript declare relationships with the following companies: Dr. Schoepf receives institutional research support from Astellas, Bayer, GE, and Siemens Healthineers. Dr. De Cecco receives institutional research support from Siemens Healthineers. Dr. Schoepf has received consulting fees / honoraria from Bayer, Guerbet, and Siemens. Drs. De Cecco and Varga-Szemes have received consulting fees from Guerbet. Dr. P. Apfaltrer receives institutional research support from Siemens Healthineers. Publisher Copyright: {\textcopyright} 2018, European Society of Radiology.",

year = "2018",

month = jul,

day = "1",

doi = "10.1007/s00330-017-5249-2",

language = "English (US)",

volume = "28",

pages = "3097--3104",

journal = "European Radiology",

issn = "0938-7994",

publisher = "Springer Verlag",

number = "7",

}

TY - JOUR

T1 - High-pitch low-voltage CT coronary artery calcium scoring with tin filtration

T2 - accuracy and radiation dose reduction

AU - Apfaltrer, Georg

AU - Albrecht, Moritz H.

AU - Schoepf, U. Joseph

AU - Duguay, Taylor M.

AU - De Cecco, Carlo N.

AU - Nance, John W.

AU - De Santis, Domenico

AU - Apfaltrer, Paul

AU - Eid, Marwen H.

AU - Eason, Chelsea D.

AU - Thompson, Zachary M.

AU - Bauer, Maximilian J.

AU - Varga-Szemes, Akos

AU - Jacobs, Brian E.

AU - Sorantin, Erich

AU - Tesche, Christian

N1 - Funding Information: The authors of this manuscript declare relationships with the following companies: Dr. Schoepf receives institutional research support from Astellas, Bayer, GE, and Siemens Healthineers. Dr. De Cecco receives institutional research support from Siemens Healthineers. Dr. Schoepf has received consulting fees / honoraria from Bayer, Guerbet, and Siemens. Drs. De Cecco and Varga-Szemes have received consulting fees from Guerbet. Dr. P. Apfaltrer receives institutional research support from Siemens Healthineers. Publisher Copyright: © 2018, European Society of Radiology.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Objectives: To investigate diagnostic accuracy and radiation dose of high-pitch CT coronary artery calcium scoring (CACS) with tin filtration (Sn100kVp) versus standard 120kVp high-pitch acquisition. Methods: 78 patients (58% male, 61.5±9.1 years) were prospectively enrolled. Subjects underwent clinical 120kVp high-pitch CACS using third-generation dual-source CT followed by additional high-pitch Sn100kVp acquisition. Agatston scores, calcium volume scores, Agatston score categories, percentile-based risk categorization and radiation metrics were compared. Results: 61/78 patients showed coronary calcifications. Median Agatston scores were 34.9 [0.7–197.1] and 41.7 [0.7–207.2] and calcium volume scores were 34.1 [0.7–218.0] for Sn100kVp and 35.7 [1.1–221.0] for 120kVp acquisitions, respectively (both p<0.0001). Bland-Altman analysis revealed underestimated Agatston scores and calcium volume scores with Sn100kVp versus 120kVp acquisitions (mean difference: 16.4 and 11.5). However, Agatston score categories and percentile-based risk categories showed excellent agreement (ĸ=0.98 and ĸ=0.99). Image noise was 25.8±4.4HU and 16.6±2.9HU in Sn100kVp and 120kVp scans, respectively (p<0.0001). Dose-length-product was 9.9±4.8mGy*cm and 40.9±14.4mGy*cm with Sn100kVp and 120kVp scans, respectively (p<0.0001). This resulted in significant effective radiation dose reduction (0.13±0.07mSv vs. 0.57±0.2mSv, p<0.0001) for Sn100kVp acquisitions. Conclusion: CACS using high-pitch low-voltage tin-filtered acquisitions demonstrates excellent agreement in Agatston score and percentile-based cardiac risk categorization with standard 120kVp high-pitch acquisitions. Furthermore, radiation dose was significantly reduced by 78% while maintaining accurate risk prediction. Key points: • Coronary artery calcium scoring with tin filtration reduces radiation dose by 78%. • There is excellent correlation between high-pitch Sn100kVp and standard 120kVp acquisitions. • Excellent agreement regarding Agatston score categories and percentile-based risk categorization was achieved. • No cardiac risk reclassifications were observed using Sn100kVp coronary artery calcium scoring.

AB - Objectives: To investigate diagnostic accuracy and radiation dose of high-pitch CT coronary artery calcium scoring (CACS) with tin filtration (Sn100kVp) versus standard 120kVp high-pitch acquisition. Methods: 78 patients (58% male, 61.5±9.1 years) were prospectively enrolled. Subjects underwent clinical 120kVp high-pitch CACS using third-generation dual-source CT followed by additional high-pitch Sn100kVp acquisition. Agatston scores, calcium volume scores, Agatston score categories, percentile-based risk categorization and radiation metrics were compared. Results: 61/78 patients showed coronary calcifications. Median Agatston scores were 34.9 [0.7–197.1] and 41.7 [0.7–207.2] and calcium volume scores were 34.1 [0.7–218.0] for Sn100kVp and 35.7 [1.1–221.0] for 120kVp acquisitions, respectively (both p<0.0001). Bland-Altman analysis revealed underestimated Agatston scores and calcium volume scores with Sn100kVp versus 120kVp acquisitions (mean difference: 16.4 and 11.5). However, Agatston score categories and percentile-based risk categories showed excellent agreement (ĸ=0.98 and ĸ=0.99). Image noise was 25.8±4.4HU and 16.6±2.9HU in Sn100kVp and 120kVp scans, respectively (p<0.0001). Dose-length-product was 9.9±4.8mGy*cm and 40.9±14.4mGy*cm with Sn100kVp and 120kVp scans, respectively (p<0.0001). This resulted in significant effective radiation dose reduction (0.13±0.07mSv vs. 0.57±0.2mSv, p<0.0001) for Sn100kVp acquisitions. Conclusion: CACS using high-pitch low-voltage tin-filtered acquisitions demonstrates excellent agreement in Agatston score and percentile-based cardiac risk categorization with standard 120kVp high-pitch acquisitions. Furthermore, radiation dose was significantly reduced by 78% while maintaining accurate risk prediction. Key points: • Coronary artery calcium scoring with tin filtration reduces radiation dose by 78%. • There is excellent correlation between high-pitch Sn100kVp and standard 120kVp acquisitions. • Excellent agreement regarding Agatston score categories and percentile-based risk categorization was achieved. • No cardiac risk reclassifications were observed using Sn100kVp coronary artery calcium scoring.

KW - Computed tomography

KW - Coronary artery calcium

KW - High-pitch

KW - Radiation dose

KW - Tin filtration

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U2 - 10.1007/s00330-017-5249-2

DO - 10.1007/s00330-017-5249-2

M3 - Article

C2 - 29404770

AN - SCOPUS:85044939855

SN - 0938-7994

VL - 28

SP - 3097

EP - 3104

JO - European Radiology

JF - European Radiology

IS - 7

ER -

High-pitch low-voltage CT coronary artery calcium scoring with tin filtration: accuracy and radiation dose reduction

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