A novel low-dose ECG-gated helical scan method to investigate coronary artery diseases was developed. This method
uses a high pitch for scanning (based on the patient's heart rate) and X-rays are generated only during the optimal cardiac
phases. The dose reduction was obtained using a two-level approach: 1) To use a 64-slice CT scanner (Aquilion,
Toshiba, Otawara, Tochigi, Japan) with a scan speed of 0.35 s/rot. to helically scan the heart at a high pitch based on the
patient's heart rate. By changing the pitch from the conventional 0.175 to 0.271 for a heart rate of 60 bpm, the exposure
dose was reduced to 65%. 2) To employ tube current gating that predicts the timing of optimal cardiac phases from the
previous cardiac cycle and generates X-rays only during the required cardiac phases. The combination of high speed
scanning with a high pitch and appropriate X-ray generation only in the cardiac phases from 60% to 90% allows the
exposure dose to be reduced to 5.6 mSv for patients with a heart rate lower than 65 bpm. This is a dose reduction of
approximately 70% compared to the conventional scanning method recommended by the manufacturer when segmental
reconstruction is considered. This low-dose protocol seamlessly allows for wide scan ranges (e.g., aortic dissection) with
the benefits of ECG-gated helical scanning: smooth continuity for longitudinal direction and utilization of data from all
cardiac cycles.
With high-speed multislice helical CT, the time needed to select the optimal cardiac phase accounts for a large percentage of the coronary CT angiography examination time because the scan time is short. To reduce the phase selection time, we have developed an automatic cardiac phase selection algorithm and implemented it in the Aquilion 64 scanner. This algorithm calculates the absolute sum of the differences between two raw data sets for subsequent cardiac phases (e.g., 4% and 0%) and generates a velocity curve representing the magnitude of cardiac motion velocity for the entire heart volume. Normally, the velocity curve has two local minimum slow-motion phases corresponding to end-systole and mid-diastole. By applying these local minimum phases in reconstruction, stationary cardiac images can be reconstructed automatically. In this report, the algorithm for generating the velocity curve and the processing time for selecting the optimal cardiac phase are discussed. The accuracy of this method is compared with that of the conventional manual method. In the manual method, a sample plane containing all four cardiac chambers was selected, reconstruction was performed for all phases at 2% intervals, and images were visually evaluated. Optimal phase selection required about 5 min/exam. With automatic phase selection, optimal phase selection required only about 1 min/exam, and the cardiac phases were close to those selected using the manual method. Automatic phase selection substantially reduces the time needed to select the optimal phase and increases patient throughput. Moreover, the influence of operator skill in selecting the optimal phase is minimized.
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