Minimized Radiation and Contrast Agent Exposure for Coronary Computed Tomography Angiography: First Clinical Experience on a Latest Generation 256-slice Scanner.

Rationale and Objectives The aim of the study was to evaluate the impact of the latest coronary computed tomography angiography (CCTA) techniques allowing a radiation- and contrast-sparing protocol on image quality in unselected patients referred for exclusion of suspected coronary artery disease (CAD). Materials and Methods This prospective study was approved by the local ethics committee, and all patients provided written informed consent. Between March and June 2015, 89 consecutive patients (61% male; mean age 55 ± 11 years) referred for exclusion of CAD by 256-slice CCTA using prospective electrocardiogram triggering were included. Tube voltage (80–120 kVp), tube current (180–310 mA) as well contrast agent volume (25–45 mL) and flow rate (3.5–5 mL/s) were adapted to body mass index. Signal intensity was measured by placing a region of interest in the aortic root, the left main artery, and the proximal right coronary artery. Image noise was measured in the aortic root. Two independent blinded readers semi-quantitatively assessed the image quality regarding motion, noise, and contrast on a 4-point scale. Results Median contrast agent volume and median effective radiation dose were 35 mL (interquartile range, 30–40 mL) and 0.5 mSv (interquartile range, 0.4–0.6 mSv), respectively. Mean attenuation in the aortic root was 412 ± 89 Hounsfield units. Diagnostic image quality was obtained in 1050 of 1067 (98.4%) coronary segments and, on an intention-to-diagnosis basis, in 85 of 89 (95.5%) patients. Below a cut-off heart rate of 67 beats/min, only 1 of 974 (0.1%) coronary segments was nondiagnostic. Conclusion A radiation- and contrast-sparing protocol for CCTA on a latest generation 256-slice computed tomography scanner yields diagnostic image quality in patients referred for CAD exclusion in daily clinical routine.