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Open AccessArticle

Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography

1
Walter Reed National Military Medical Center, Bethesda, MD, USA
2
Uniformed Services University of the Health Sciences, Bethesda, MD, USA
3
Department of Radiology, Yale New Haven Hospital, New Haven, CT, USA
4
Brooke Army Medical Center, Fort Sam Houston, TX, USA
5
University of Virginia Health Center, Charlottesville, VA, USA
*
Author to whom correspondence should be addressed.
Tomography 2020, 6(4), 356-361; https://doi.org/10.18383/j.tom.2020.00041
Received: 6 September 2020 / Revised: 5 October 2020 / Accepted: 4 November 2020 / Published: 1 December 2020
Extensive coronary artery calcium (CAC) diminishes the accuracy of coronary computed tomography angiography (CCTA). Many imagers adjust CCTA acquisition parameters depending on a preCCTA Agatston CAC score to optimize diagnostic accuracy. Typical preCCTA CAC imaging adds considerably to radiation exposure, partially attributable to imaging beyond the area known for highest CAC, the proximal coronary arteries. We aimed to determine whether a z-axis reduced scan length (RSL) would identify the majority of CAC and provide adequate information to computed tomography angiography providers relative to a standard full-scan length (FSL) preCCTA noncontrast CT. We retrospectively examined 200 subjects. The mean CAC scores detected in RSL and FSL were 77.4 (95% CI 50.6 to 104.3) and 93.9 (95% CI 57.3 to 130.5), respectively. RSL detected 81% of the FSL CAC. Among false negatives, with no CAC detected in RSL, FSL CAC severity was minimal (mean score 2.8). There was high concordance, averaging 88%, between CCTA imaging parameter adjustment decisions made by 2 experienced imagers based on either RSL or FSL. CAC detected and decision concordance decreased with increasing CAC burden. CAC detected was lower, and false negatives were more common in the right coronary artery owing to its anatomic course, placing larger segments outside RSL. Axial scan length and effective dose decreased 59% from FSL (∼14.5 cm/∼1.1 mSv) to RSL (∼5.9 cm/∼0.45 mSv). This retrospective study suggests that RSL identifies most CAC, results in similar CCTA acquisition parameter modifications, and reduces radiation exposure. Our colleagues corroborated these results in a recently published prospective study.
Keywords: radiation dose; coronary calcium score; cardiac CT; coronary CT angiography radiation dose; coronary calcium score; cardiac CT; coronary CT angiography
MDPI and ACS Style

Young, C.R.; Reynolds, D.A.; Gambill, N.; Brooks, D.I.; Villines, T.C. Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography. Tomography 2020, 6, 356-361. https://doi.org/10.18383/j.tom.2020.00041

AMA Style

Young CR, Reynolds DA, Gambill N, Brooks DI, Villines TC. Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography. Tomography. 2020; 6(4):356-361. https://doi.org/10.18383/j.tom.2020.00041

Chicago/Turabian Style

Young, Colin R.; Reynolds, David A.; Gambill, Neil; Brooks, Daniel I.; Villines, Todd C. 2020. "Reduced Axial Scan Length Coronary Calcium Scoring Reduces Radiation Dose and Provides Adequate Clinical Decision-Making Before Coronary CT Angiography" Tomography 6, no. 4: 356-361. https://doi.org/10.18383/j.tom.2020.00041

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