Study of optimal exposure windows using 320-Detector rows dynamic volume CT

Gang Sun¹, Min Li¹, Li Li¹, Guo-ying Li¹, Zhi-wei Jing^2
1Departments of Medical Imaging, ²Medical Statistics, Jinan Military General Hospital, Shandong Province, China

Abstract: The purpose of this study was to determine the optimal electrocardiographic (ECG) pulsing windows and evaluate the effect on reduced dose and accuracy using 320-detector rows dynamic volume computed tomography (DVCT). A total of 170 patients were prospectively studied. The optimal reconstruction windows were analyzed in 76 patients scanned using retrospective ECG gating. Forty-seven patients were scanned by the predicted triggering windows. The optimal positions of exposure intervals according to different heart rates were evaluated. Optimal image quality, radiation dose, and diagnostic accuracy were then investigated by applying optimal triggering windows. The optimal ECG pulsing windows were determined as follows: when heart rate was <70 beats per minute, the exposure windows should be preset at 60%–80%; for a heart rate 70–90 beats per minute at 70%–90%; and for a heart rate ≥90 beats per minute at 30%–50%. The radiation dose for patients scanned with prospective ECG gating was significantly lower (5.9 versus 12.9 mSv, P < 0.001). However, because two or three heart beats were needed when heart rate was >70 beats per minute, the radiation dose increased with increasing heart rate for both retrospective and prospective ECG gating (r = 0.64, P < 0.001 and r = 0.59, P < 0.001, respectively). On the basis of a per segment analysis, overall sensitivity was 98.0% (49/50), specificity was 99.2% (602/607), the positive predictive value was 90.7% (49/54), and the negative predictive value was 99.8% (602/603). In conclusion, DVCT has the potential to provide high image quality across a wide range of heart rates using an optimized ECG pulsing window. However, it is recommended to control heart rate below 70 beats per minute, if possible, to decrease the radiation dose.

Keywords: dynamic volume computed tomography, coronary angiography, optimal exposure window, heart rate, radiation dose