评估 SCOT-HEART 试验中稳定型胸痛患者的辐射暴露。
Evaluating Radiation Exposure in Patients with Stable Chest Pain in the SCOT-HEART Trial.
机构信息
From the British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh, UK (J.C., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.); Department of Radiology, Ninewells Hospital, Dundee, UK (P.G.R.); Clinical Research Imaging Facility, University of Dundee, UK (P.G.R.); Department of Medical Physics, NHS Lothian, Edinburgh, UK (N.W.W.); Edinburgh Imaging Facility QMRI, University of Edinburgh, Edinburgh, UK (N.W.W., M.R.D., N.L.M., D.E.N., E.J.R.v.B., M.C.W.); University of Cambridge, Cambridge, UK (J.R.W.M.); Royal Papworth Hospital, Cambridge, UK (J.R.W.M.); Department of Radiology, Royal Infirmary of Scotland, Edinburgh, UK (A.N., E.J.R.v.B., M.C.W.); Blavatnik Family Women's Health Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY (L.J.S.); Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, and Department of Radiology, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, NY (A.J.E.); and Institute of Clinical Sciences, University of Glasgow, UK (G.R.).
出版信息
Radiology. 2023 Aug;308(2):e221963. doi: 10.1148/radiol.221963.
Background In the Scottish Computed Tomography of the Heart (SCOT-HEART) trial in individuals with stable chest pain, a treatment strategy based on coronary CT angiography (CTA) led to improved outcomes. Purpose To assess 5-year cumulative radiation doses of participants undergoing investigation for suspected angina due to coronary artery disease with or without coronary CTA. Materials and Methods This secondary analysis of the SCOT-HEART trial included data from six of 12 recruiting sites and two of three imaging sites. Participants were recruited between November 18, 2010, and September 24, 2014, with follow-up through January 31, 2018. Study participants had been randomized (at a one-to-one ratio) to standard care with CT ( = 1466) or standard care alone ( = 1428). Imaging was performed on a 64-detector ( = 223) or 320-detector row scanner ( = 1466). Radiation dose from CT (dose-length product), SPECT (injected activity), and invasive coronary angiography (ICA; kerma-area product) was assessed for 5 years after enrollment. Effective dose was calculated using conversion factors appropriate for the imaging modality and body region imaged (using 0.026 mSv/mGy · cm for cardiac CT). Results Cumulative radiation dose was assessed in 2894 participants. Median effective dose was 3.0 mSv (IQR, 2.6-3.3 mSv) for coronary calcium scoring, 4.1 mSv (IQR, 2.6-6.1 mSv) for coronary CTA, 7.4 mSv (IQR, 6.2-8.5 mSv) for SPECT, and 4.1 mSv (IQR, 2.5-6.8 mSv) for ICA. After 5 years, total per-participant cumulative dose was higher in the CT group (median, 8.1 mSv; IQR, 5.5-12.4 mSv) compared with standard-care group (median, 0 mSv; IQR, 0-4.5 mSv; < .001). In participants who underwent any imaging, cumulative radiation exposure was higher in the CT group ( = 1345; median, 8.6 mSv; IQR, 6.1-13.3 mSv) compared with standard-care group ( = 549; median, 6.4 mSv; IQR, 3.4-9.2 mSv; < .001). Conclusion In the SCOT-HEART trial, the 5-year cumulative radiation dose from cardiac imaging was higher in the coronary CT angiography group compared with the standard-care group, largely because of the radiation exposure from CT. Clinical trial registration no. NCT01149590 © RSNA, 2023 See also the editorial by Dodd and Bosserdt in this issue.
背景 在苏格兰稳定胸痛的计算机断层扫描心脏（SCOT-HEART）试验中，基于冠状动脉 CT 血管造影（CTA）的治疗策略导致了结局的改善。
目的 评估疑似因冠状动脉疾病接受调查的患者在接受冠状动脉 CTA 检查时的 5 年累积辐射剂量。
材料和方法 这项 SCOT-HEART 试验的二次分析纳入了来自 12 个招募点中的 6 个和 3 个影像学点中的 2 个的数据。参与者于 2010 年 11 月 18 日至 2014 年 9 月 24 日之间被随机（1:1 比例）分配至接受标准护理加 CT（ = 1466）或标准护理（ = 1428）。影像学检查使用 64 排（ = 223）或 320 排探测器 CT（ = 1466）。在入组后 5 年内，评估了 CT（剂量长度乘积）、SPECT（注射活性）和有创冠状动脉造影（ICA；有效面积乘积）的辐射剂量。使用适用于成像方式和成像部位的转换系数（心脏 CT 为 0.026 mSv/mGy·cm）计算有效剂量。
结果 在 2894 名参与者中评估了累积辐射剂量。冠状动脉钙评分的中位有效剂量为 3.0 mSv（IQR，2.6-3.3 mSv），冠状动脉 CTA 为 4.1 mSv（IQR，2.6-6.1 mSv），SPECT 为 7.4 mSv（IQR，6.2-8.5 mSv），ICA 为 4.1 mSv（IQR，2.5-6.8 mSv）。5 年后，CT 组（中位数，8.1 mSv；IQR，5.5-12.4 mSv）的每位参与者的总累积剂量高于标准护理组（中位数，0 mSv；IQR，0-4.5 mSv；<.001）。在接受任何影像学检查的参与者中，CT 组（ = 1345；中位数，8.6 mSv；IQR，6.1-13.3 mSv）的累积辐射暴露高于标准护理组（ = 549；中位数，6.4 mSv；IQR，3.4-9.2 mSv；<.001）。
结论 在 SCOT-HEART 试验中，与标准护理组相比，冠状动脉 CTA 组的心脏成像 5 年累积辐射剂量更高，这主要是因为 CT 带来的辐射暴露。
临床试验注册号 NCT01149590
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