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Improved cardiac results with Ingenuity CT in real world setting

White Paper
Philips CT Clinical Science Philips Healthcare • USA

Overview
Philips iPatient enables users to achieve consistent image quality while managing dose appropriately every day. With the iPatient user interface, the Philips Ingenuity CT provides features that facilitate the use of patient-specific dose management tools for increased diagnostic confidence. This intuitive user interface can help to increase workflow and efficiency, with integrated functionality designed to enhance real-time decision-making.

Following is an example demonstrating the use and performance of Ingenuity CT with iPatient technology at a private practice clinic in Australia.

Perth Radiological Clinic (PRC, Perth, Western Australia) is a private practice clinic comprised of approximately 70 radiologists. It is a leading provider of private medical imaging services in Western Australia and is recognized nationally as a leader in diagnostic medical imaging.

PRC operates the radiology department for the Joondalup Health Campus and Shenton House. The Shenton House facility is a large outpatient radiology facility servicing the northern suburbs in the Perth region, with a population of about 200,000. PRC Shenton House has an imaging department which includes a Philips Ingenuity CT (with iPatient) installed in early 2014.
 <em>Perth Radiological Clinic (PRC) - Perth, Western Australia</em>
Perth Radiological Clinic (PRC) - Perth, Western Australia

Study
Within three months of the Ingenuity CT installation, PRC Shenton House introduced a new non-invasive cardiac imaging service using the scanner. As with any imaging center initiating a new cardiac imaging program, PRC Shenton House set up a startup (learning) phase, to not only study the capability of the system, but to also learn about patient preparation. 50 coronary CT angiography (CTA) studies were performed on the scanner as part of this startup phase. During this phase, the protocols were continuously adjusted for patient body habitus (based on height, weight, body mass index [BMI], or water equivalent diameter [WED] as determined from the surview). In addition, patient selection, patient preparation (both in and out of room), contrast injection, and scan protocols were continuously optimized. Radiation dose was optimized by using low energy (80 kVp and 100 kVp) in 94% of the patients.

In addition, electrocardiogram (ECG)-triggered, prospectively gated axial scans (Step & Shoot Cardiac) were used in 72% of the patients. Images were reconstructed using a standard cardiac kernel (XCB), along with noise-reducing hybrid iterative technique (iDose4). As part of planning the diagnostic scan, the WED in combination with a targeted dose right index (DRI), was used to continuously optimize the tube energy (kVp) and output (mAs) to deliver consistent image quality. In parallel, the contrast injection protocol was also optimized in order to obtain an attenuation of at least 350 Hounsfield Units (HU) in the aortic root for optimal enhancement of the coronary arteries and the left chambers. Helical scans with or without electrocardiogram (ECG)-tube current modulation were prescribed in cases where the risk of an aberrant beat during the scan was considered high based on the presence of a significant amount of ectopic beats prior to the exam or irregular heart rate during the calcium scoring exams. Of these first 50 patients during the startup phase, diagnostic quality images were obtained in 84% of cases.

Since then, PRC Shenton House has built upon that experience, performing high-quality coronary CTA on the Ingenuity CT using iPatient. Based on the experience gained during the startup phase, the combination of WED and DRI was used to guide appropriate kVp and mAs selection, with low energy (80 kVp and 100 kVp) scans used in 82% of the patients. Additionally, 78% of the studies were performed using Step & Shoot Cardiac. An average contrast attenuation of 527 HU was achieved in the aortic root across all cases (with 97% of cases above the targeted threshold of 350 HU). These optimized protocols resulted in coronary CTA scans of high quality, with 90% of the scans considered diagnostic for the detection and rule-out of coronary artery disease (CAD). Although 10% of the cases were nondiagnostic, 20% of those were caused by uncontrolled patient motion (secondary to coughing, panic attack, etc). The reasons for nondiagnostic results in the remaining cases were attributed to circumstances widely published in clinical literature (e.g., coronary motion).1-3

Conclusion
For PRC Shenton House, Philips Ingenuity CT with iPatient has a demonstrated real-world ability to allow for expanded diagnostic offerings, including the enhanced image quality necessary for diagnostic confidence in coronary CT exams.

References
  1. Neefjes LA, Dharampal AS, Rossi A, Nieman K, Weustink AC, Dijkshoorn ML, Ten Kate GJ, Dedic A, Papadopoulou SL, van Straten M, Cademartiri F, Krestin GP, de Feyter PJ, Mollet NR. Image quality and radiation exposure using different low-dose scan protocols in dual-source CT coronary angiography: Randomized study. Radiology. 2011 Dec;261(3):779-86. doi: 10.1148/radiol.11110606. PMID: 219696662.
  2. Leschka S, Stolzmann P, Desbiolles L, Baumueller S, Goetti R, Schertler T, Scheffel H, Plass A, Falk V, Feuchtner G, Marincek B, Alkadhi H. Diagnostic accuracy of high-pitch dual-source CT for the assessment of coronary stenoses: First experience. Eur Radiol. 2009 Dec;19(12):2896-903. doi: 10.1007/s00330-009-1618-9. PMID: 197602293.
  3. Budoff MJ, Achenbach S, Duerinck A. Clinical utility of computed tomography and magnetic resonance techniques for noninvasive coronary angiography. J Am Coll Cardiol. 2003 Dec 3;42(11):1867-78. Review. PMID: 14662244 ©2017


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White Paper
Ingenuity CT
Calcium Scoring, Cardiac, contrast, coronary angiography, coronary arteries, coronary artery disease, dose, ECG-gated, iDose4, image quality, iPatient, prospective, Prospectively gated axial technique, rule-out, Step & Shoot Cardiac, Vascular
 

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