Personalization of injection protocols to the individual patient's blood volume and automated tube voltage selection (ATVS) in coronary CTA

• Published in: PloS one Vol. 13; no. 9; p. e0203682
• Main Authors: Eijsvoogel, Nienke G, Hendriks, Babs M F, Willigers, Jef L, Martens, Bibi, Carati, Luc F, Horehledova, Barbora, Kietselaer, Bastiaan L J H, Crijns, Harry J G M, Wildberger, Joachim E, Das, Marco
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 26.09.2018; Public Library of Science (PLoS)
• Subjects: Abdomen; Angiography; Attenuation; Automation; Biology and Life Sciences; Blood; Blood volume; Body mass index; Cardiology; Cardiovascular disease; CAT scans; Computed tomography; Contrast agents; Contrast media; Coronary vessels; Diagnosis; Diagnostic systems; Drug dosages; EKG; Electric potential; Flow velocity; Heart; Heart diseases; Image quality; Immunoglobulins; Injection; Medical diagnosis; Medical imaging; Medical tests; Medicine and Health Sciences; Noise; Nuclear medicine; Patients; Physical Sciences; Quality assessment; Research and Analysis Methods; Segments; Voltage; Netherlands; Germany
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0203682

The aim was to assess personalised contrast media (CM) protocols-based on patient's blood volume (BV) and automated tube voltage selection (ATVS)-in coronary computed tomography angiography (CCTA). A total of 114 consecutive patients received an ECG-triggered or ECG-gated helical scan on a 3rd-generation dual-source CT with 70-120kV (ATVS) and 330mAsqual.ref. CM was adapted to BV, scan time (s) and kV. Image quality (IQ) was assessed in a 17-segment coronary model using attenuation values (HU), contrast-to-noise (CNR), signal-to-noise ratio (SNR) (objective IQ) and a Likert scale (subjective IQ: 1 = poor/2 = sufficient/3 = good/4 = excellent). ig. Patient distribution was: n = 60 for 70kV, n = 37 80kV and n = 17 90kV. Mean BV was 5.4±0.6L for men and 4.1±0.6L for women. Mean CM volume (300 mg I/mL) and flow rate were: 30.9±6.4mL and 3.3±0.5mL/s (70kV); 40.8±7.1mL and 4.5±0.6mL/s (80kV); 53.6±8.6mL and 5.7±0.6mL/s (90kV). Overall mean HU was >300HU in 98.2% (112/114) of patients. Overall mean attenuation was below 300HU in two scans (70kV) due to late scan timing. Of 1.661 segments, 95.4% was assessable. Mean CNR was 14±4(70kV), 13±3(80kV) and 14±4(90kV); mean SNR was 10±2(both 70kV+80kV) and 9±2(90kV). Objective IQ was comparable between kV settings, protocols and sex. Subjective IQ was diagnostic in all scans and excellent-sufficient in 95.4% of segments. Personalisation of CCTA CM injection protocols to BV and ATVS is a promising technique to tailor CM administration to the individual patient, while maintaining diagnostic IQ.