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To the Editor: The study by Dr Raff and colleagues¹ demonstrated that the implementation of a radiation dose-reduction program for cardiac computed tomography angiography (CCTA) may be effective. In addition, the authors noted that there was no significant change in the median image quality assessment in the control compared with the follow-up period. However, Table 2 indicates an increase in the proportion of studies with poor or nondiagnostic scores from the control period to the follow-up period (4.2% vs 7.7%, respectively). Although the median score of image quality remained unchanged, the observation that approximately 1 in every 13 studies were nondiagnostic in the follow-up period is of concern.

Several potential causes (other than chance) may explain this relatively high number of nondiagnostic scans. First, modification of scan parameters such as tube voltage and tube current modulation with implementation of the dose-reduction protocol could have affected the perception of physicians who . . . [Full Text of this Article]

Felipe S. Torres, MD
felipe.torres@uhn.on.ca

Andrew M. Crean, MD; Narinder Paul, MD
Toronto General Hospital
Toronto, Ontario, Canada

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Radiation Dose From Cardiac Computed Tomography Before and After Implementation of Radiation Dose–Reduction Techniques
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Radiation Dose-Reduction Program for Cardiac Computed Tomography Angiography—Reply
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