Assessment of image quality and radiation dose of prospectively ECG-triggered adaptive dual-source coronary computed tomography angiography (cCTA) with arrhythmia rejection algorithm in systole versus diastole: a retrospective cohort study

  • Ashley M. Lee
  • Jonathan Beaudoin
  • Leif-Christopher Engel
  • Manavjot S. Sidhu
  • Suhny Abbara
  • Thomas J. Brady
  • Udo Hoffmann
  • Brian B. Ghoshhajra
Original Paper


In this study, we sought to evaluate the image quality and effective radiation dose of prospectively ECG-triggered adaptive systolic (PTA-systolic) dual-source CTA versus prospectively triggered adaptive diastolic (PTA-diastolic) dual-source CTA in patients of unselected heart rate and rhythm. This retrospective cohort study consisted of 41 PTA-systolic and 41 matched PTA-diastolic CTA patients whom underwent clinically indicated 128-slice dual source CTA between December 2010 to June 2012. Image quality and motion artifact score (both on a Likert scale 1–4 with 4 being the best), effective dose, and CTDIvol were compared. The effect of heart rate (HR) and heart rate variability [HRV] on image motion artifact score and CTDIvol was analyzed with Pearson’s correlation coefficient. All 82 exams were considered diagnostic with 0 non-diagnostic segments. PTA-systolic CTA patients had a higher maximum HR, wider HRV, were less likely to be in sinus rhythm, and received less beta-blocker vs. PTA-diastolic CTA patients. No difference in effective dose was observed (PTA-systolic vs. PTA-diastolic CTA: 2.9 vs. 2.2 mSv, p = 0.26). Image quality score (3.3 vs. 3.5, p < 0.05) and motion artifact score (3.5 vs. 3.8, p < 0.05) were lower in PTA-systolic CTAs than in PTA-diastolic CTAs. For PTA-systolic CTAs, an increase in HR was not associated with a negative impact on motion artifact score nor CTDIvol. For PTA-diastolic CTA, an increase in HR was associated with increased motion artifacts and CTDIvol. HRV demonstrated no correlation with motion artifact and CTDIvol for both PTA-systolic and PTA-diastolic CTAs. In conclusion, both PTA-diastolic CTA and PTA-systolic CTA yielded diagnostic examinations at unselected heart rates and rhythms with similar effective radiation, but PTA-systolic CTA resulted in more consistent radiation exposure and image quality across a wide range of rates and rhythms.


Radiation dosage Systole Coronary computed tomography angiography 


Conflict of interest



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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Ashley M. Lee
    • 1
  • Jonathan Beaudoin
    • 1
  • Leif-Christopher Engel
    • 1
  • Manavjot S. Sidhu
    • 1
  • Suhny Abbara
    • 1
  • Thomas J. Brady
    • 1
  • Udo Hoffmann
    • 1
  • Brian B. Ghoshhajra
    • 1
  1. 1.Cardiac MR PET CT Program, Division of Cardiology and Department of RadiologyMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

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