Carotid CTA: Radiation Exposure and Image Quality with the Use of Attenuation-Based, Automated Kilovolt Selection

Authors: A. Eller, W. Wuest, M. Kramer, M. May, A. Schmid, M. Uder and M.M. Lell


CTA is considered the imaging modality of choice in evaluating the supraaortic vessels in many institutions, but radiation exposure remains a matter of concern. The objective of the study was to evaluate a fully automated, attenuation-based kilovolt selection algorithm in carotid CTA in respect to radiation dose and image quality compared with a standard 120-kV protocol.


Ninety-eight patients were included: 53 examinations (patient age, 66 ± 12 years) were performed by use of automated adaption of tube potential (80–140 kV) on the basis of the attenuation profile of the scout scan (study group), and 45 examinations (patient age, 67 ± 11 years) were performed by use of a standard 120-kV protocol (control group). CT dose index volume and dose-length product were recorded from the examination protocol. Image quality was assessed by ROI measurements and calculations of SNR and contrast-to-noise ratio. Subjective image quality was evaluated by 2 observers with the use of a 4-point scale (3, excellent; 0, not diagnostic).


Subjective image quality was rated as “excellent” or “good” in all examinations (study group, 2.8; control group, 2.8). The algorithm automatically selected 100 kV in 47% and 80 kV in 34%; 120 kV was retained in 19%. An elevation to 140 kV did not occur. Compared with the control group, overall CT dose index volume reduction was 33.7%; overall dose-length product reduction was 31.5%. In the low-kilovolt scans, image noise and mean attenuation of ROIs inside the carotid arteries were significantly higher than in 120-kV scans, resulting in a constant or increased (80-kV group) contrast-to-noise ratio.


The attenuation-based, kilovolt selection algorithm enables a dose reduction of >30% in carotid artery CTA while maintaining contrast-to-noise ratio and subjective image quality at adequate levels.