CT - Chapter 4 Flashcards
What is the appropriate recommendation for optimization of CCTA?
- Arm position
- EKG leads
- NTG dosing
- Breath hold commands
- Arm position –> over head
- EKG leads –> leads are placed peripherally and not over the center of the chest
- NTG dosing –> coronary vasodilation with SL NTG 0.4 - 0.8 mg
- Breath hold commands –> slow breath hold commands
What is the resultant reduction in radiation dose to the patient when reducing scan length (z-axis) by 2 cm or more?
30%
- reducing scan length from
- 16 cm to 14 cm –> 33% radiation reduction
- 16 cm to 12 cm –> 47% radiation reduction
Describe CAC with use of MDCT system of 320 detector rows
often do not use the maximum possible number of slices
- full coverage not used to avoid cone beam artifacts if axial scanning ( e.g. prospective ECG-triggering) is used
Describe the relationship:
- Retropsective ECG-gated CT
- CAC with use of MDCT system of 320 detector rows
- can use the full available detector coverage
- cone beam artifacts can be eliminated with special helical reconstruction techniques
What are the radiation doses for the studies?
- Retrospective ECG-gated CCTA
- Prospective ECG-gated CCTA
- CAC
- Annual natural background radiation
- Retrospective ECG-gated CCTA –> 12-14 mSv (max - 20 mSv)
- Prospective ECG-gated CCTA –> 2-3 mSv
- CAC –> < 1 mSv (0.9 mSv)
- Annual natural background radiation –> 2.4 mSv
What are advantages of acquiring cardiac CT images using dual energy settings (“spectral” CT) vs. standard single energy acquisition?
- better tissue characterization
- reduction of beam hardening and other artifacts
- improved image quality
- particularly in the setting of severe coronary calcification
Describe the findings


What is the preferred protocol for delayed enhancement/viability?
- 65 year old male
- BMI 22 kg/m2
100 kVp is preferred over 120 kVp
- iodine enhancement can be visualized better due to –>
- better low contrast resolution with 100 kVp approach
What is the potential disadvantage of arrhythmia rejection software?
- Bradycardia
- PAC’s
Radiation dose may be substantially increased
- software monitors R-R cycle length for a finite time prior to scanning
- if R wave peak occurs sooner than the average (with an arrhythmia) –>
- switch from prospective –> retrospective (continuous) scanning
- saves image quality but at the expense of increased radiation
What scan mode is required for high-pitch CCTA?
Prospective-ECG synchronized helical scan mode
- scan is triggered at 60% R-R interval and
- all images acquired during systole within 0.3s
What are the reduction in radiation associated with these adjustments?
- Prospective ECG Triggering
- Decrease tube current to 300 mA
- Decrease tube voltage to 100 kVp
- Breast shielding
- Prospective ECG Triggering –> 70-90%
- Decrease tube voltage to 100 kVp –> 40-50%
- Decrease tube current to 300 mA –> 30-50%
- Breast shielding –> 50-60% (but may compromise image quality)
What is the acceptable contrast iodine concentration that can be utilized for CCTA?
► 300 mg/mL
What are the key strategies for dose reduction in cardiac CT?
- Should not be performed in patients with high CAC
- diagnostic accuracy is attenuated
- Individualize scan length to minimum needed to cover the area of interest
- ECG-based tube current modulation should be applied in all patients with NSR
- Peak tube voltage should be 100 kVp in non-obese patients ( < 85-90kg )
- Prospectively ECG-triggered CT should be considered in patiets with a stable and low HR
- < 65 bpm
What is the recommended filter in CAC aqcuisition?
medium-sharp reconstruction filter kernel without edge enhancement
- provides moderate image noise in low-dose acquisition protocols
- helps avoid overestimation of scores and artifacts in the pericardium
What does high-pitch CCTA at 100 kVp allow for?
- Pitch
- Scan time
- Radiation dose
- Pitch –> 3.4
- Scan time –> 0.3s
- Radiation dose –> 1 mSv
What is the recommendation for CT evaluation of the LAA in a patient already undergoing CT evaluation of the pulmoary veins for A-fib ablation?
Acquire a second set of images limited to the LA and LAA 45-60s after the first pass images
- first scan may demonstrate filling defect:
- poor mixing of contrast –> resolves
- deprived LAA function
- thrombus

What is one additional requirement when performing “triple rule-out?”
Larger contrast volume
What parameter is used to determine contrast volume necessary when performing CCTA?
Scan length / time
- typically 60-80 mL are injected
- followed by saline bolus
What clinical scenario requires a decreased flow rate of CCTA?
Triple rule-out protocol
- simultaneous imaging of the coronary arteries, pulmonary arteries and thoracic aorta requires a longer “plateau” phase of the contrast bolus
- decrease flow rate to 4 - 4.5 cc/s is suggested
When should oral BB be administered prior to CCTA?
60 minutes
What patient-related factor is the MOST difficult for which to compensate?
- 64-slice multidetector cardiac CT study
Respiration during scan
- can create numerous non-correctible imaging artifacts
How can these patient-related factors be overcome or compensated for?
- Obesity with large BMI
- Rapid HR ( > 80 bpm)
- Normal HR with PVC’s and bigeminy
- Obesity with large BMI –>
- higher mA with a smooth reconstruction kernel
- Rapid HR ( > 80 bpm)
- multisegmet reconstruction or
- using a dual source scanner with a better temporal resolution
- Normal HR with PVC’s and bigeminy
- End-systolic reconstructions and ECG editing
What is the appropriate peak tube voltage?
- MDCT protocols
- congenital heart evaluation
- up to 2 years of age
70-80 kVp
What CT protocols should be used for cardiac acquisition in a newborn with congenital heart disease to minimize radiation exposure?
- Prospectively ECG-triggered or Non-gated helical acquisitions with:
- Submillimeter collimation (necessary)

