Automated attenuation-based selection of tube voltage and tube current for coronary CT angiography: Reduction of radiation exposure versus a BMI-based strategy with an expert investigator

Background: Recently developed automated algorithms use the topogram and the corresponding attenuation information before coronary CT angiography (CTA) to allow for an individualized anatomic-based selection of tube current (mAs) and voltage (kV). Objectives: The value of these algorithms in reducing the associated radiation exposure was evaluated. Methods: One hundred patients underwent coronary CTA with dual-source CT with prospectively electrocardiogram-triggered axial data acquisition. In all patients, tube parameters (current and voltage) were suggested by both an experienced investigator according to the patient's body mass index (BMI; calculated as weight divided by height squared; kg/m(2)) and by an automated software according to attenuation values of the initial topogram. The first 50 consecutive patients (group 1) underwent coronary CTA with dual-source CT with tube parameters suggested by the experienced investigator (BMI-based tube parameters), whereas in another 50 consecutive patients (group 2) CT data acquisition was performed with tube settings of the automated software. Subsequently, subjective image quality (4-point rating score from 0 = nondiagnostic to 3 = excellent image quality), image noise (SD of CT number within the aortic root), as well as signal- and contrast-to-noise ratios and mean effective radiation doses, were compared between both groups. Results: Both groups showed comparable image quality parameters (group 1 vs 2: noise, 28.1 +/- 6.0 HU vs 29.9 +/- 5.4 HU, P = .12; signal-to-noise ratio, 16.4 +/- 3.9 vs 16.8 +/- 4.1, P = .54; contrast-to-noise ratio, 18.6 +/- 4.1 vs 19.2 +/- 4.3, P = .49; 4-point rating score, 2.8 +/- 0.3 vs 2.9 +/- 0.3, P = .81). Tube voltage, current, and mean effective radiation dose for groups 1 and 2 were 111 +/- 12 kV and 108 +/- 12 kV (P = .18), 361 +/- 32 mAs and 320 +/- 48 mAs (P < .001), and 2.3 mSv (25th; 75th percentile, 1.5; 2.8 mSv) and 1.4 mSv (25th; 75th percentile, 1.1; 1.9 mSv) (P < .001), respectively. Conclusions: Automated attenuation-based selections of individualized tube parameters are superior to BMI-based selections with expert oversight and show a potential for reduction of radiation exposure in coronary CTA, and image quality is maintained. (C) 2013 Society of Cardiovascular Computed Tomography. All rights reserved.