Personalization of injection protocols to the individual patient's blood volume and automated tube voltage selection (ATVS) in coronary CTA

Nienke G Eijsvoogel; Babs M F Hendriks; Jef L Willigers; Bibi Martens; Luc F Carati; Barbora Horehledova; Bastiaan L J H Kietselaer; Harry J G M Crijns; Joachim E Wildberger; Marco Das

doi:10.1371/journal.pone.0203682

Personalization of injection protocols to the individual patient's blood volume and automated tube voltage selection (ATVS) in coronary CTA

PLoS One. 2018 Sep 26;13(9):e0203682. doi: 10.1371/journal.pone.0203682. eCollection 2018.

Authors

Nienke G Eijsvoogel^{1

2}, Babs M F Hendriks^{1

2}, Jef L Willigers¹, Bibi Martens^{1

2}, Luc F Carati¹, Barbora Horehledova^{1

2}, Bastiaan L J H Kietselaer^{1

2

3}, Harry J G M Crijns^{2

3}, Joachim E Wildberger^{1

2}, Marco Das^{1

4}

Affiliations

¹ Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
² CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands.
³ Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
⁴ Department of Diagnostic and Interventional Radiology, Helios Kliniken Duisburg, Duisburg, Germany.

Abstract

Purpose: The aim was to assess personalised contrast media (CM) protocols-based on patient's blood volume (BV) and automated tube voltage selection (ATVS)-in coronary computed tomography angiography (CCTA).

Methods: A total of 114 consecutive patients received an ECG-triggered or ECG-gated helical scan on a 3rd-generation dual-source CT with 70-120kV (ATVS) and 330mAsqual.ref. CM was adapted to BV, scan time (s) and kV. Image quality (IQ) was assessed in a 17-segment coronary model using attenuation values (HU), contrast-to-noise (CNR), signal-to-noise ratio (SNR) (objective IQ) and a Likert scale (subjective IQ: 1 = poor/2 = sufficient/3 = good/4 = excellent). ig.

Results: Patient distribution was: n = 60 for 70kV, n = 37 80kV and n = 17 90kV. Mean BV was 5.4±0.6L for men and 4.1±0.6L for women. Mean CM volume (300 mg I/mL) and flow rate were: 30.9±6.4mL and 3.3±0.5mL/s (70kV); 40.8±7.1mL and 4.5±0.6mL/s (80kV); 53.6±8.6mL and 5.7±0.6mL/s (90kV). Overall mean HU was >300HU in 98.2% (112/114) of patients. Overall mean attenuation was below 300HU in two scans (70kV) due to late scan timing. Of 1.661 segments, 95.4% was assessable. Mean CNR was 14±4(70kV), 13±3(80kV) and 14±4(90kV); mean SNR was 10±2(both 70kV+80kV) and 9±2(90kV). Objective IQ was comparable between kV settings, protocols and sex. Subjective IQ was diagnostic in all scans and excellent-sufficient in 95.4% of segments.

Conclusions: Personalisation of CCTA CM injection protocols to BV and ATVS is a promising technique to tailor CM administration to the individual patient, while maintaining diagnostic IQ.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Blood Volume*
Computed Tomography Angiography / methods*
Contrast Media / administration & dosage
Coronary Vessels / diagnostic imaging*
Female
Humans
Image Enhancement
Male
Middle Aged

Substances

Contrast Media

Grants and funding

MD receives institutional grants from Philips, Siemens and Bayer and personal fees (speakers bureau) from Cook, Siemens and Bayer. JEW reports institutional research grants from Philips, AGFA, GE, BRACCO, Siemens and Bayer and personal fees (speakers bureau) from Siemens and Bayer. The specific roles of these authors are articulated in the 'author contributions' section. The funders did not have any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.