A prospective national survey of coronary CT angiography radiation doses in the United Kingdom

Isabel A Castellano; Edward D Nicol; Russell K Bull; Carl A Roobottom; Michelle C Williams; Stephen P Harden

doi:10.1016/j.jcct.2017.05.002

A prospective national survey of coronary CT angiography radiation doses in the United Kingdom

J Cardiovasc Comput Tomogr. 2017 Jul-Aug;11(4):268-273. doi: 10.1016/j.jcct.2017.05.002. Epub 2017 May 8.

Authors

Isabel A Castellano¹, Edward D Nicol², Russell K Bull³, Carl A Roobottom⁴, Michelle C Williams⁵, Stephen P Harden⁶

Affiliations

¹ Joint Department of Physics, The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ, UK. Electronic address: elly.castellano@rmh.nhs.uk.
² Radiology Department, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP, UK. Electronic address: e.nicol@rbht.nhs.uk.
³ Department of Radiology, Royal Bournemouth Hospital, Castle Lane East, Bournemouth, BH7 7DW, UK. Electronic address: Russell.Bull@rbcn.nhs.uk.
⁴ Radiology Department, Derriford Hospital, Derriford Rd, Plymouth, PL6 8DH, UK. Electronic address: carl.roobottom@nhs.net.
⁵ Centre for Cardiovascular Science, University of Edinburgh, Royal Infirmary of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, UK. Electronic address: michelle.williams@ed.ac.uk.
⁶ Department of Cardiothoracic Radiology, University Hospital Southampton, Tremona Road, Southampton, SO16 6YD, UK. Electronic address: stephen.harden@uhs.nhs.uk.

PMID: 28532693
DOI: 10.1016/j.jcct.2017.05.002

Abstract

Background: Little real-world radiation dose data exist for the majority of cardiovascular CT. Some data have been published for coronary CT angiography (coronary CTA) specifically, but they invariably arise from high-volume centres with access to the most recent technology.

Objective: The aim of this study was to document real-world radiation doses for coronary CTA in the United Kingdom, and to establish their relationship to clinical protocol selection, acquisition heart rate, and scanner technology.

Methods: A dose survey questionnaire was distributed to members of the British Society of Cardiovascular Imaging and other UK cardiac CT units. All participating centres collected data for consecutive coronary CTA cases over one month. The survey captured information about the exam conducted, patient demographics, pre-scan details such as beta-blocker administration, acquisition heart rate and scan technique, and post-scan dose indicators - series volumetric CT dose index (CTDI_vol), series dose-length product (DLP), and exam DLP.

Results: Fifty centres provided data on a total of 1341 coronary CTA exams. Twenty-nine centres (58%) performed at least 20 coronary CTA scans in the collection period. The median BMI, acquisition heart rate and exam DLP were 28 kg/m², 60 bpm and 209 mGycm respectively. The corresponding effective dose was estimated as 5.9 mSv using a conversion factor of 0.028 mSv/mGycm. There was no statistically significant difference in radiation dose between low and high-volume centres. Median exam DLP increased with the acquisition heart rate due to the selection of wider temporal windows. The highest exam DLPs were obtained on the older scanner technology.

Conclusion: This study provides baseline data for benchmarking practice, optimizing radiation dose and improving service quality locally.

Keywords: Coronary CT angiography; Dose-length product; Quality improvement; Radiation dose; Radiation dose survey.

MeSH terms

Benchmarking
Body Mass Index
Computed Tomography Angiography* / adverse effects
Computed Tomography Angiography* / standards
Coronary Angiography / adverse effects
Coronary Angiography / methods*
Coronary Angiography / standards
Coronary Artery Disease / diagnostic imaging*
Coronary Artery Disease / physiopathology
Coronary Vessels / diagnostic imaging*
Health Care Surveys
Heart Rate
Hospitals, High-Volume
Hospitals, Low-Volume
Humans
Predictive Value of Tests
Prospective Studies
Quality Improvement
Quality Indicators, Health Care
Radiation Dosage*
Radiation Exposure* / adverse effects
Radiation Exposure* / standards
Risk Factors
United Kingdom