A Low Tube Voltage Technique Reduces the Radiation Dose at Retrospective ECG-gated Cardiac Computed Tomography for Anatomical and Functional Analyses

Abstract

To investigate the effect of low-tube-voltage technique on a cardiac computed tomography (CT) for coronary arterial and cardiac functional analyses and radiation dose in slim patients. We enrolled 80 patients (52women, 28 men; mean age, 68.7 ± 8.9 years) undergoing retrospective electrocardiogram-gated 64-slice cardiac CT. Forty were subjected to the low (80-kV) and 40 to the standard (120-kV) tube-voltage protocol. Quantitative parameters of the coronary arteries (ie, CT attenuation, image noise, and the contrast-to-noise ratio [CNR]) were calculated, as were the effective radiation dose and the figure of merit (FOM). Each coronary artery segment was visually evaluated using a 5-point scale. Cardiac function calculated by using low-tube-voltage cardiac CT was compared with that on echocardiographs. CT attenuation and image noise were significantly higher at 80- than 120-kV (P < .01). CNR of the left and right coronary artery was 18.4 ± 3.8 and 18.5 ± 3.3, respectively, at 80 kV; these values were 19.7 ± 2.7 and 19.8 ± 2.8 at 120 kV; the difference was not significant. The estimated effective radiation dose was significantly lower at 80 than 120 kV (6.3 ± 0.6 vs. 13.9 ± 1.1 mSv, P < .01) and FOM was significantly higher at 80 than 120 kV (P < .01). At visual assessment, 99% of the coronary segments were diagnostic quality; the two protocols did not differ significantly. We observed a strong correlation and good agreement between low-tube-voltage cardiac CT and echocardiography for cardiac functional analyses. Low-tube-voltage cardiac CT significantly reduced the radiation dose by approximately 55% in slim patients while maintaining anatomical image quality and accuracy of cardiac functional analysis.