Multi-detector row spiral CT angiography of the thoracic outlet: dose reduction with anatomically adapted online tube current modulation and preset dose savings

Purpose: To evaluate image quality obtained with anatomically adapted online tube current modulation and preset minimum dose savings at multi-detector row spiral computed tomographic (CT) angiography of the thoracic outlet.

Materials and methods: A total of 100 patients were evaluated for thoracic outlet arterial syndrome with spiral CT angiography (collimation, 4 x 1 mm; pitch, 1.75) both with and without dose reduction by means of anatomically adapted online tube current modulation and preset minimum dose savings. Preset minimum savings of 20% and of 32% were applied in two groups of 50 patients (groups 1 and 2). In each group, low-dose scanning was performed in 25 patients in the neutral position and in 25 patients after postural maneuver. Tube current-time product, noise, presence and quality of graininess and of linear streak artifacts on transverse CT scans, and diagnostic value of sagittal reformations and volume-rendered images were evaluated and recorded for each data set. chi2 test was used to compare frequencies; paired Wilcoxon rank test, to compare subjective and objective image quality scores. P <.05 indicated a significant difference.

Results: In group 1, mean tube current-time product was 3225 mAs for reference scans and 2101 mAs for low-dose scans (mean reduction, 35%; range, 27%-47%). In group 2, mean was 3070 mAs for reference scans and 2068 mAs for low-dose scans (mean reduction, 33%; range, 17%-38%). In group 1, no differences in frequencies of graininess and linear streaking or in noise level were found between images acquired with or without dose reduction. In group 2, no difference was found in noise level between low-dose and reference scans. On low-dose scans, moderate linear streaking was observed with lower frequency and moderate graininess was observed with higher frequency, but artifacts did not compromise image quality or prevent confident assessment of arterial diameter in the three compartments of the thoracic outlet.

Conclusion: Online tube current modulation with a preset minimum dose saving of 20% allowed 35% reduction in mean tube current-time product, with no loss in image quality.