ArticleJACC. Cardiovascular imaging2020
Application of Low Tube Potentials in CCTA: Results From the PROTECTION VI Study.
Article in JACC. Cardiovascular imaging, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02996903 (Prospective Multicenter Registry On RadiaTion Dose Estimates Of Cardiac CT AngIOgraphy IN Daily Practice in 2017), which is not on this map. Cited by 27 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Prospective Multicenter Registry On RadiaTion Dose Estimates Of Cardiac CT AngIOgraphy IN Daily Practice in 2017
Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it.
- SCCT 2021 Expert Consensus Document on Coronary Computed Tomographic Angiography: A Report of the Society of Cardiovascular Computed Tomography.Journal of cardiovascular computed tomographyGuideline
- High-strength deep learning image reconstruction in coronary CT angiography at 70-kVp tube voltage significantly improves image quality and reduces both radiation and contrast doses.European radiology · 2022Trial
- Radiation and Contrast Medium Dosage Optimization of Coronary CT Angiography While Combining Personalized Patient Protocol Technology and Automated Tube Voltage Selection Technology.Diagnostics (Basel, Switzerland) · 2026Article
- Visceral arterial disease: imaging features and pattern-based evaluation on CT angiography.Abdominal radiology (New York) · 2026Review
- Radiation dose optimization in coronary CT angiography clinical application of absolute phase gating in patients with atrial fibrillation.Journal of applied clinical medical physics · 2026Article
- Radiation Dose Reduction in Coronary Computed Tomography Angiography.JACC. Case reports · 2025Article
- Radiation Dose Optimization in a Multicenter CCTA Program.JACC. Case reports · 2025Article
- The application value of deep learning-based reconstruction combined with segmented contrast injection in "one-stop" cardio-cerebrovascular computed tomography angiography.Quantitative imaging in medicine and surgery · 2025Article
- Effect of Deep Learning Image Reconstruction on Image Quality and Pericoronary Fat Attenuation Index.Journal of imaging informatics in medicine · 2025Article
- Feasibility Study of Triple-low CCTA for Coronary Artery Disease Screening Combining Contrast Enhancement Boost and Deep Learning Reconstruction.Reviews in cardiovascular medicine · 2025Article
- Thoracic CT Angiographies in Children Using Automated Power Injection with Bolus Tracking Versus Manual Contrast Injection: Analysis of Contrast Enhancement, Image Quality and Radiation Exposure.Diagnostics (Basel, Switzerland) · 2025Article
- Novel intravascular tantalum oxide-based contrast agent achieves improved vascular contrast enhancement and conspicuity compared to Iopamidol in an animal multiphase CT protocol.European radiology experimental · 2024Article
- Current and Emerging Approaches for Primary Prevention of Coronary Artery Disease Using Cardiac Computed Tomography.Current cardiology reports · 2024Review
- Quantitative analysis of blooming artifact caused by calcification based on X-ray energy difference using computed tomography.Scientific reports · 2024Article
- The application value of a vendor-specific deep learning image reconstruction algorithm in "triple low" head and neck computed tomography angiography.Quantitative imaging in medicine and surgery · 2024Article
- Halved contrast medium dose coronary dual-layer CT-angiography - phantom study of tube current and patient characteristics.The international journal of cardiovascular imaging · 2024Article
- Influencing factors and improvement methods of coronary artery plaque evaluation in CT.Frontiers in cardiovascular medicine · 2024Review
- Potential for Dose Reduction in CT-Derived Left Ventricular Ejection Fraction: A Simulation Study.Tomography (Ann Arbor, Mich.) · 2023Article
- Technical Recommendations for Computed Tomography Guidance of Intervention in the Right Ventricular Outflow Tract: Native RVOT, Conduits, and Bioprosthetic Valves.World journal for pediatric & congenital heart surgery · 2023Article
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18 authors.
Funding
Abstract
objectivesThe aim of this study was to assess the use of low tube potentials for coronary computed tomography angiography (CCTA) in worldwide clinical practice and its influence on radiation exposure, contrast agent volume, and image quality.
backgroundCCTA is frequently used in clinical practice. Lowering of tube potential is a potent method to reduce radiation exposure and to economize contrast agent volume.
methodsCCTAs of 4,006 patients from 61 international study sites were analyzed regarding very-low (≤80 kVp), low (90 to 100 kVp), conventional (110 to 120 kVp), and high (≥130 kVp) tube potentials. The impact on dose-length product (DLP) and contrast agent volume was analyzed. Image quality was determined by evaluation of the diagnostic applicability and assessment of the objective image parameters signal-to-noise-ratio (SNR) and contrast-to-noise-ratio (CNR).
resultsWhen compared with conventional tube potentials, low tube potentials were used in 56% of CCTAs (≤80 kVp: 9%; 90 to 100 kVp: 47%), which varied among sites from 0% to 100%. Tube potential reduction was associated with low-cardiovascular risk profile, low body mass index (BMI), and new-generation scanners. Median radiation exposure was lowered by 68% or 50% and median contrast agent volume by 25% or 13% for tube potential protocols of ≤80 kVp or 90 to 100 kVp when compared with conventional tube potentials, respectively (all p < 0.001). With the use of lower tube potentials, the frequency of diagnostic scans was maintained (p = 0.41), whereas SNR and CNR significantly improved (both p < 0.001). Considering BMI eligibility criteria, 58% (n = 946) of conventionally scanned patients would have been suitable for low tube potential protocols, and 44% (n = 831) of patients scanned with 90 to 100 kVp would have been eligible for very-low tube potential CCTA imaging of ≤80 kVp.
conclusionsThis large international registry confirms the feasibility of tube potential reduction in clinical practice leading to lower radiation exposure and lower contrast volumes. The current registry also demonstrates that this strategy is still underused in daily practice. (PROspective multicenter registry on radiaTion dose Estimates of cardiac CT angIOgraphy iN daily practice in 2017 [PROTECTION-VI]; NCT02996903).
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