Imaging Techniques in Coronary CT

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.00
Safety: 0.25
Radiation Safety and Dose: 0.25
Image Production: 0.50
Image Formation: 0.50
Procedures: 1.25
Neck and Chest: 1.25

Registered Radiologist Assistant: 1.25
Procedures: 1.25
Thoracic Section: 1.25

Outline

1. Introduction
2. Standard Coronay CT and Its Limitations
   1. Standard Retrospective ECG-gated Helical Scan
   2. Radiation Exposure and Cancer Risk
   3. Retrospective ECG-gated Helical Scan with ECG-controlled Tube Current Modulation
   4. Low-tube Voltage Scan
   5. Limitations of Standard Coronary CT
      1. Insufficient Spatial Resolution
      2. Bean-hardening Artifacts
      3. Insufficient Temporal Resolution
      4. Stair-step Artifacts
      5. No functional Assessment
3. Current and Novel Imaging Techniques of Coronary CT
   1. Prospective ECG-gated Axial Scan (Step-and-Shoot Scan
   2. Iterative Reconstruction
   3. High-Definition CT
   4. Dual-Source CT
   5. Prospective ECG-gated High-Pitch Dual-Source Helical Scan
   6. Motion Correction Algorithm
   7. Intelligent Boundary Registration
   8. Dual-Energy CT
      1. Dual-Source CT Scanner
      2. Single-Source CT Scanner with Fast Switching of Tube Voltage
      3. Bean-hardening Correction
      4. Monochromatic Images
      5. Material Density Images
      6. Coronary Plaque Component Analysis
      7. Myocardial Perfusion Imaging
   9. FFR Derived from CT
4. Summary

Objectives

Upon completion of this course, students will:

1. be familiar with the patient population that will benefit from coronary CT
2. identify the limitations in the usefulness of coronary CT
3. identify the imaging solutions to reduce radiation dose in coronary CT
4. be familiar with the capabilities enabled by ECG recording in coronary CT
5. identify the imaging solution for decreasing beam hardening in coronary CT
6. identify the imaging solution for improving spatial resolution in coronary CT
7. identify the imaging solution for increasing contrast enhancement in coronary CT
8. be familiar with the expression for radiation dose in coronary CT
9. be familiar with the use of dose length product in coronary CT
10. be familiar with the radiation dose associated with retrospective ECG-gated helical scanning
11. recognize the patient populations at greater cancer risk from the radiation dose in coronary CT
12. understand the relationship of radiation dose to tube voltage
13. understand the relationship of voltage to iodinated contrast attenuation
14. be familiar with the artifact resulting from partial volume effect
15. understand the artifacts related to insufficient temporal resolution
16. be familiar with the primary cause of stair-step artifacts in coronary CT
17. be familiar with the methods of radiation reduction using the step-and-shoot axial scanning technique
18. identify the advantages of using iterative reconstruction algorithms in coronary CT
19. identify the disadvantages of using iterative reconstruction algorithms in coronary CT
20. be familiar with iterative reconstruction algorithms in coronary CT
21. be familiar with the reduction in radiation dose using adaptive statistical iterative reconstruction
22. be familiar with the improved contrast resolution in high-definition CT
23. be familiar with the angle of the x-ray tubes in dual-source CT
24. understand the effects of dual-source CT on temporal resolution
25. be familiar with the discontinued use of beta blockers due to the use of dual-source CT in coronary CT
26. understand the significant reduction in radiation dose associated with using ECG-gated high-pitch dual-source helical CT
27. be familiar with the heart rate limitations for using ECG-gated high-pitch dual-source helical CT
28. be familiar with the advantages of using motion correction in coronary CT
29. be familiar with the advantages of using intelligent boundary registration in coronary CT
30. be familiar with the advantages of using single-source dual-energy CT with fast switching tube voltage in coronary CT
31. be familiar with the advantages of using material density images in coronary CT
32. be familiar with the use of color-coded iodine maps for detection of myocardial perfusion defects
33. be familiar with the use of FFR
34. be able to identify the current and novel imaging solutions not used in coronary CT
35. be able to identify the current and novel imaging solutions used in coronary CT