Skip to main content
Log in

The impact of CT radiation dose reduction and iterative reconstruction algorithms from four different vendors on coronary calcium scoring

  • Cardiac
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To analyse the effects of radiation dose reduction and iterative reconstruction (IR) algorithms on coronary calcium scoring (CCS).

Methods

Fifteen ex vivo human hearts were examined in an anthropomorphic chest phantom using computed tomography (CT) systems from four vendors and examined at four dose levels using unenhanced prospectively ECG-triggered protocols. Tube voltage was 120 kV and tube current differed between protocols. CT data were reconstructed with filtered back projection (FBP) and reduced dose CT data with IR. CCS was quantified with Agatston scores, calcification mass and calcification volume. Differences were analysed with the Friedman test.

Results

Fourteen hearts showed coronary calcifications. Dose reduction with FBP did not significantly change Agatston scores, calcification volumes and calcification masses (P > 0.05). Maximum differences in Agatston scores were 76, 26, 51 and 161 units, in calcification volume 97, 27, 42 and 162 mm3, and in calcification mass 23, 23, 20 and 48 mg, respectively. IR resulted in a trend towards lower Agatston scores and calcification volumes with significant differences for one vendor (P < 0.05). Median relative differences between reference FBP and reduced dose IR for Agatston scores remained within 2.0–4.6 %, 1.0–5.3 %, 1.2–7.7 % and 2.6–4.5 %, for calcification volumes within 2.4–3.9 %, 1.0–5.6 %, 1.1–6.4 % and 3.7–4.7 %, for calcification masses within 1.9–4.1 %, 0.9–7.8 %, 2.9–4.7 % and 2.5–3.9 %, respectively. IR resulted in increased, decreased or similar calcification masses.

Conclusions

CCS derived from standard FBP acquisitions was not affected by radiation dose reductions up to 80 %. IR resulted in a trend towards lower Agatston scores and calcification volumes.

Key points

• In this ex vivo study, radiation dose could be reduced by 80 % for coronary calcium scoring

• Iterative reconstruction resulted in a trend towards lower Agatston scores and calcification volumes

• Caution should be taken for coronary calcium scoring with iterative reconstruction

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

AIDR 3D:

adaptive iterative dose reduction 3D

ASIR:

adaptive statistical iterative reconstruction

CCS:

coronary calcium score

CT:

computed tomography

CTDIvol :

volumetric CT dose index

ECG:

electrocardiogram

FBP:

filtered back projection

HU:

Hounsfield units

ICC:

intraclass correlation coefficient

IR:

iterative reconstruction

SAFIRE:

sinogram-affirmed iterative reconstruction

References

  1. Greenland P, Alpert JS, Beller GA et al (2010) 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 56:e50–e103

    Article  PubMed  Google Scholar 

  2. Lloyd-Jones D, Adams RJ, Brown TM et al (2010) Heart disease and stroke statistics–2010 update: a report from the American Heart Association. Circulation 121:e46–e215

    Article  PubMed  Google Scholar 

  3. Vliegenthart R, Oudkerk M, Hofman A et al (2005) Coronary calcification improves cardiovascular risk prediction in the elderly. Circulation 112:572–577

    Article  PubMed  Google Scholar 

  4. Detrano R, Guerci AD, Carr JJ et al (2008) Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 358:1336–1345

    Article  CAS  PubMed  Google Scholar 

  5. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC (2004) Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA 291:210–215

    Article  CAS  PubMed  Google Scholar 

  6. Rumberger JA, Brundage BH, Rader DJ, Kondos G (1999) Electron beam computed tomographic coronary calcium scanning: a review and guidelines for use in asymptomatic persons. Mayo Clin Proc 74:243–252

    Article  CAS  PubMed  Google Scholar 

  7. Jacobs PC, Gondrie MJ, van der Graaf Y et al (2012) Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose CT screening for lung cancer. AJR Am J Roentgenol 198:505–511

    Article  PubMed  Google Scholar 

  8. Lu B, Budoff MJ, Zhuang N et al (2002) Causes of interscan variability of coronary artery calcium measurements at electron-beam CT. Acad Radiol 9:654–661

    Article  PubMed  Google Scholar 

  9. McCollough CH, Ulzheimer S, Halliburton SS, Shanneik K, White RD, Kalender WA (2007) Coronary artery calcium: a multi-institutional, multimanufacturer international standard for quantification at cardiac CT. Radiology 243:527–538

    Article  PubMed  Google Scholar 

  10. Braunwald E (2006) Epilogue: what do clinicians expect from imagers? J Am Coll Cardiol 47:C101–C103

    Article  PubMed  Google Scholar 

  11. Youssef G, Kalia N, Darabian S, Budoff MJ (2013) Coronary calcium: new insights, recent data, and clinical role. Curr Cardiol Rep 15:325

    Article  PubMed Central  PubMed  Google Scholar 

  12. Kim KP, Einstein AJ, de Berrington GA (2009) Coronary artery calcification screening: estimated radiation dose and cancer risk. Arch Intern Med 169:1188–1194

    Article  PubMed Central  PubMed  Google Scholar 

  13. Willemink MJ, de Jong PA, Leiner T et al (2013) Iterative reconstruction techniques for computed tomography Part 1: technical principles. Eur Radiol 23:1623–1631

    Article  PubMed  Google Scholar 

  14. Willemink MJ, Leiner T, de Jong PA et al (2013) Iterative reconstruction techniques for computed tomography part 2: initial results in dose reduction and image quality. Eur Radiol 23:1632–1642

    Article  PubMed  Google Scholar 

  15. Mohlenkamp S, Behrenbeck TR, Pump H et al (2001) Reproducibility of two coronary calcium quantification algorithms in patients with different degrees of calcification. Int J Cardiovasc Imaging 17:133–142

    Article  CAS  PubMed  Google Scholar 

  16. Rutten A, Isgum I, Prokop M (2008) Coronary calcification: effect of small variation of scan starting position on Agatston, volume, and mass scores. Radiology 246:90–98

    Article  PubMed  Google Scholar 

  17. Oudkerk M, Stillman AE, Halliburton SS et al (2008) Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Eur Radiol 18:2785–2807

    Article  PubMed  Google Scholar 

  18. Ghadri JR, Goetti R, Fiechter M et al (2011) Inter-scan variability of coronary artery calcium scoring assessed on 64-multidetector computed tomography vs. dual-source computed tomography: a head-to-head comparison. Eur Heart J 32:1865–1874

    Article  PubMed  Google Scholar 

  19. Gebhard C, Fiechter M, Fuchs TA et al (2012) Coronary artery calcium scoring: influence of adaptive statistical iterative reconstruction using 64-MDCT. Int J Cardiol 167:2932–2937

    Article  PubMed  Google Scholar 

  20. Funabashi N, Irie R, Aiba M et al (2013) Adaptive-iterative-dose-reduction 3D with multisector-reconstruction method in 320-slice CT may maintain accurate-measurement of the Agatston-calcium-score of severe-calcification even at higher pulsating-beats and low tube-current in vitro. Int J Cardiol 168:601–603

    Article  PubMed  Google Scholar 

  21. Love A, Olsson ML, Siemund R, Stalhammar F, Bjorkman-Burtscher IM, Soderberg M (2013) Six iterative reconstruction algorithms in brain CT: a phantom study on image quality at different radiation dose levels. Br J Radiol 86:20130388

    Article  CAS  PubMed  Google Scholar 

  22. Budoff MJ, Kessler P, Gao YL, Qunibi W, Moustafa M, Mao SS (2008) The interscan variation of CT coronary artery calcification score: analysis of the calcium acetate renagel comparison (CARE)-2 study. Acad Radiol 15:58–61

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The scientific guarantor of this publication is Dr. Tim Leiner. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was not required because the hearts were from deceased subjects who donated their bodies to science, approval by a research ethics committee was not necessary. These hearts were from deceased subjects who donated their bodies to science. Written informed consent on using their entire body for research and educational purposes was obtained during life. Methodology: prospective, experimental, multicentre study.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Martin J. Willemink.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Willemink, M.J., Takx, R.A.P., de Jong, P.A. et al. The impact of CT radiation dose reduction and iterative reconstruction algorithms from four different vendors on coronary calcium scoring. Eur Radiol 24, 2201–2212 (2014). https://doi.org/10.1007/s00330-014-3217-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-014-3217-7

Keywords

Navigation