Effective radiation doses associated with non-invasive versus invasive assessment of coronary anatomy and physiology

Catheter Cardiovasc Interv. 2015 Jun;85(7):1173-81. doi: 10.1002/ccd.25729. Epub 2014 Nov 22.


Objectives: To compare the effective radiation dose (ERD) needed to obtain information on coronary anatomy and physiology by a non-invasive versus an invasive diagnostic strategy.

Background: Knowledge of anatomy and physiology is needed for management of patients with coronary artery disease (CAD). There is, however, a growing concern about detrimental long-term effects of radiation associated with diagnostic procedures.

Methods: In a total of 671 patients with suspected CAD, we compared the ERD needed to obtain anatomical and physiological information through a non-invasive strategy or an invasive strategy. The non-invasive strategy consisted of coronary computed tomography angiography (CCTA) and single photon emission computed tomography (SPECT). The invasive strategy included coronary angiography (CA) and fractional flow reserve (FFR) measurement. In 464 patients, the data were acquired in Period 2009 and in 207 the data were acquired in Period 2011 (after each period, the CCTA- and the CA-equipment had been upgraded).

Results: For the Period 2009 total ERD of the non-invasive approach was significantly larger compared to the invasive approach (28.45 ± 5.37 mSv versus 15.79 ± 7.95 mSv, respectively; P < 0.0001). For Period 2011, despite the significant decrease in ERD for both groups (P<0.0001 for both), the ERD remained higher for the non-invasive approach compared to the invasive approach (16.67 ± 10.45 mSv vs. 10.36 ± 5.87 mSv, respectively; P < 0.0001). Simulation of various diagnostic scenarios showed cumulative radiation dose is the lowest when a first positive test is followed by an invasive strategy.

Conclusion: To obtain anatomic and physiologic information in patients with suspected CAD, the combination of CA and FFR is associated with lower ERD than the combination of CCTA and SPECT.

Keywords: coronary artery disease; effective radiation dose; fractional flow reserve; invasive diagnostic strategy; non-invasive diagnostic strategy.

Publication types

  • Comparative Study
  • Observational Study

MeSH terms

  • Aged
  • Cardiac Catheterization
  • Coronary Angiography / adverse effects
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / physiopathology
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / physiopathology
  • Female
  • Fractional Flow Reserve, Myocardial*
  • Humans
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Myocardial Perfusion Imaging / adverse effects
  • Myocardial Perfusion Imaging / methods*
  • Predictive Value of Tests
  • Prognosis
  • Radiation Dosage*
  • Registries
  • Risk Assessment
  • Risk Factors
  • Time Factors
  • Tomography, Emission-Computed, Single-Photon
  • Tomography, X-Ray Computed* / adverse effects