A novel ultrafast-low-dose computed tomography protocol allows concomitant coronary artery evaluation and lung cancer screening

BMC Cardiovasc Disord. 2018 May 8;18(1):90. doi: 10.1186/s12872-018-0830-4.


Background: Cardiac computed tomography (CT) is often performed in patients who are at high risk for lung cancer in whom screening is currently recommended. We tested diagnostic ability and radiation exposure of a novel ultra-low-dose CT protocol that allows concomitant coronary artery evaluation and lung screening.

Methods: We studied 30 current or former heavy smoker subjects with suspected or known coronary artery disease who underwent CT assessment of both coronary arteries and thoracic area (Revolution CT, General Electric). A new ultrafast-low-dose single protocol was used for ECG-gated helical acquisition of the heart and the whole chest. A single IV iodine bolus (70-90 ml) was used. All patients with CT evidence of coronary stenosis underwent also invasive coronary angiography.

Results: All the coronary segments were assessable in 28/30 (93%) patients. Only 8 coronary segments were not assessable in 2 patients due to motion artefacts (assessability: 98%; 477/485 segments). In the assessable segments, 20/21 significant stenoses (> 70% reduction of vessel diameter) were correctly diagnosed. Pulmonary nodules were detected in 5 patients, thus requiring to schedule follow-up surveillance CT thorax. Effective dose was 1.3 ± 0.9 mSv (range: 0.8-3.2 mSv). Noteworthy, no contrast or radiation dose increment was required with the new protocol as compared to conventional coronary CT protocol.

Conclusions: The novel ultrafast-low-dose CT protocol allows lung cancer screening at time of coronary artery evaluation. The new approach might enhance the cost-effectiveness of coronary CT in heavy smokers with suspected or known coronary artery disease.

Keywords: Computed tomography; Coronary artery disease; Lung cancer screening; Smoker; Ultrafast low-dose.

MeSH terms

  • Aged
  • Cardiac-Gated Imaging Techniques
  • Computed Tomography Angiography / adverse effects
  • Computed Tomography Angiography / methods*
  • Coronary Angiography / adverse effects
  • Coronary Angiography / methods*
  • Coronary Artery Disease / diagnostic imaging*
  • Coronary Artery Disease / etiology
  • Coronary Stenosis / diagnostic imaging*
  • Coronary Stenosis / etiology
  • Early Detection of Cancer / adverse effects
  • Early Detection of Cancer / methods*
  • Electrocardiography
  • Female
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / etiology
  • Male
  • Middle Aged
  • Pilot Projects
  • Predictive Value of Tests
  • Radiation Dosage*
  • Radiation Exposure / adverse effects
  • Radiation Exposure / prevention & control*
  • Risk Factors
  • Smoking / adverse effects*
  • Workflow