Effect of Computed Tomography Slice Thickness on Calculated Coronary Artery Calcium Score in the Assessment of Possible Radiation Induced Cardiac Toxicity

Abstract

Studies have suggested that the occurrence of radiation induced cardiac toxicity in breast cancer patients is significantly higher in women with pre-existing cardiac risk factors. Therefore, it is important to quantify the relationship between radiation induced cardiac toxicity and a measurable level of pre-existing cardiac risk such as the patient’s coronary artery calcium Agatston score. To assess the extent of coronary artery calcium present in the walls of patients’ coronary arteries before they received treatment, Agatston scores may be calculated using thoracic CT scans acquired for external beam radiotherapy planning. However, these planning CT scans can vary in slice thickness and resolution, thus complicating the calculation of calcium scores using scans with slice thicknesses other than the 3mm routinely employed for traditional Agatston scoring. The objective of this project is to quantify the effect of varying CT scan slice thickness in the calculation of coronary artery calcium scores so that a method of standardization might be developed. This is accomplished through the design, fabrication, and scanning of an anthropomorphic phantom featuring calcium inserts of varying sizes. Analysis of how the scores change with increasing slice thickness is used to construct a simple linear scaling method of standardization which corrects for varying slice thickness and the resulting partial volume distortions. A linear scaling method was successfully validated for the calculation of coronary artery calcium Agatston scores across a range of slice thicknesses increasing from 0.625 mm to 5 mm. Scaling is applied by multiplying the score by the slice thickness and dividing by 3 mm. This method is potentially applicable in any clinical or research endeavour which calls for retroactive cardiac calcium quantification. With a simple linear scaling method, external beam radiation therapy planning CT scans with slice thicknesses ranging from 0.625 mm to 5 mm can be used to calculate coronary artery calcium Agatston scores and thereby measure a patient’s level of cardiac risk before treatment.