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In Reply: Dr Torres and colleagues convey an important concern regarding the potential degradation of CCTA image quality as a consequence of decreased radiation dose. We agree that applying best-practice guidelines to decrease radiation exposure should not come at the expense of reduced scan quality.

Their suggestions of potential causes of increased numbers of poor or nondiagnostic quality scans are very reasonable. There is another potential cause that we did not quantify but might have been operative. The proportion of scans done at lower tube voltage (100 kVp) significantly increased during the course of our study (from 13% to 43%; P < .001). This had a beneficial effect on radiation dose, but due to the absorption spectrum of iodine would tend to increase the efficiency of absorption of photons at the lower voltage. The result is CT angiograms with a higher mean contrast level than scans done at 120 kVp. This . . . [Full Text of this Article]

Gilbert L. Raff, MD
graff@beaumont.edu

Kavitha M. Chinnaiyan, MD
Cardiology Division
William Beaumont Hospital
Royal Oak, Michigan

Aiden Abidov, MD, PhD
Sarver Heart Center
College of Medicine
University of Arizona
Tucson

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RELATED LETTER

Radiation Dose-Reduction Program for Cardiac Computed Tomography Angiography
Felipe S. Torres, Andrew M. Crean, and Narinder Paul
JAMA. 2009;302(16):1753.
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