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Vascular CT and MRI: a practical guide to imaging protocols
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Ct image database
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When the heart rate is low we use beta blockers to lower the heart rate appropriately , usually the image quality is very reliable in most clinical situations.
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Retrospective gating was more commonly used in the past and this is the technique that brought a lot of the bad reputation in terms of dose to cardiac CT. The dose penalty is a result of the way data is acquired. As a comparison, when we perform body CT we use a pitch of 1, which means that the table translates to about the same width as the collimation of the entire detector, but with cardiac CT we do not advance the table as quickly, which results in the over-scanning, or over-radiation of the patient.
So we acquire a lot of redundant data. We do this because we want to retrospectively pick, from those redundant data, only those phases that we use to reconstruct images, which would make it seem like the entire data set was acquired in the diastolic phase for example. So the redundancy of data acquisition enables the phase-selective reconstruction, but it also increases the radiation dose.
In the old days, it took maybe 30 sec to acquire a cardiac scan, but now we can acquire the same scan in about 5 or 6 sec. The benefit to having all of that redundant data is that you can reconstruct any phase of the cardiac cycle. Since scanners today have a much better temporal resolution, we can see the cardiac cycle in 20 phases with high detail of the aortic valve and the mitral valve.
Practical CT Techniques
When we want to evaluate the valves, having this information throughout the cardiac cycle is necessary. Now, the redundant helical data acquisition, which is the cause of the high radiation dose of EKG retrospectively gated CT is really the underlying problem. Attempts have been made to diminish this problem by using EKG modulation. In principle it is a very good idea.
These modulation techniques contributed to a decreased radiation dose. In the past you could only do EKG modulation if the heart rate was regular, because when you up- and down-regulate tube currents, you do so depending on the information of previous RR peaks. If the heart rate is irregular, it was possible that the dose would be insufficient during some of cardiac phases.
New versions of EKG dose modulation have more refined methods, which actually look longer into the RR phases or R peak intervals. This functionality is available on our dual-source scanners. This allows us to substantially reduce dose. Figure 1 is a graph that shows the dose ranges of retrospectively and prospectively gated scans. In clinical practice we usually use retrospective gating with our dual-source scanner. If the heart rate is low, we can pulse only during the diastolic phase.
If the heart rate is higher, we pulse from late systolic to the diastolic phase. Figure 2 is a case where we had the highest dose that we have observed in clinical use of coronary CTA. This was due to the fact that the patient had atrial fibrillation, and the patient was on the heavier side. Despite the use of EKG pulsing, it was hardly ever triggered because the scanner automatically refused to down-modulate because it noticed that the heart rate was so irregular. Skip to main content.
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Schlosser T, Scheuermann T, Ulzheimer S et al In vitro evaluation of coronary stents and in-stent stenosis using a dynamic cardiac phantom and a detector row CT scanner. Ritman EL Cardiac computed tomography imaging: a history and some future possibilities. Radiology 1 —85 PubMed Google Scholar.