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Gilbert L. Raff, MD; Kavitha M. Chinnaiyan, MD; David A. Share, MD, MPH; Tauqir Y. Goraya, MD, PhD; Ella A. Kazerooni, MD; Mauro Moscucci, MD; Ralph E. Gentry, RT; Aiden Abidov, MD, PhD; for the Advanced Cardiovascular Imaging Consortium Co-Investigators

JAMA. 2009;301(22):2340-2348.

Context  Cardiac computed tomography angiography (CCTA) can accurately diagnose coronary artery disease, but radiation dose from this procedure is of concern.

Objectives  To determine whether a collaborative radiation dose–reduction program would be associated with reduced radiation dose in patients undergoing CCTA in a statewide registry over a 1-year period and to define its effect on image quality.

Design, Setting, and Patients  A prospective, controlled, nonrandomized study conducted during a control period (July-August 2007), an intervention period (September 2007-April 2008), and a follow-up period (May-June 2008) at 15 hospital imaging centers participating in the Advanced Cardiovascular Imaging Consortium in Michigan, which included small community hospitals and large academic medical centers. A total of 4995 sequential patients undergoing CCTA for suspected coronary artery disease were enrolled; 4862 patients (97.3%) had complete radiation data for analysis.

Intervention  A best-practice CCTA scan model was used, which included minimized scan range, heart rate reduction, electrocardiographic-gated tube current modulation, and reduced tube voltage in suitable patients.

Main Outcome Measures  Primary outcomes included dose-length product and effective radiation dose from all phases of the CCTA scan. Secondary outcomes were image quality assessed by a 4-point scale (1 indicated excellent; 2, good; 3, adequate; and 4, nondiagnostic) and frequency of diagnostic-quality scans.

Results  Compared with the control period, patients' estimated median radiation dose in the follow-up period was reduced by 53.3% (dose-length product decreased from 1493 mGy x cm [interquartile range {IQR}, 855-1823 mGy x cm] to 697 mGy x cm [IQR, 407-1163 mGy x cm]; P < .001) and effective dose from 21 mSv (IQR, 12-26 mSv) to 10 mSv (IQR, 6-16 mSv) (P < .001). The greatest reduction in dose occurred at low-volume sites. There were no significant changes in median image quality assessment during the control period compared with the follow-up period (median image quality of 2 [images rated as good] vs median image quality of 2; P = .13) or frequency of diagnostic-quality scans (554/620 patients [89%] vs 769/835 patients [92%]; P = .07).

Conclusion  Consistent application of currently available dose-reduction techniques was associated with a marked reduction in estimated radiation doses in a statewide CCTA registry, without impairment of image quality.

Trial Registration  clinicaltrials.gov Identifier: NCT00640068

Author Affiliations: Cardiology Division, William Beaumont Hospital, Royal Oak, Michigan (Drs Raff, Chinnaiyan, and Abidov and Mr Gentry); Department of Family Medicine, University of Michigan Health System (Dr Share), Radiology Department, University of Michigan Medical School (Dr Kazerooni), and University of Michigan Cardiovascular Center (Dr Moscucci), University of Michigan, Ann Arbor; Michigan Heart PC, Ann Arbor (Dr Goraya); and Cardiovascular Division, Miller School of Medicine, University of Miami, Miami, Florida (Dr Moscucci).

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