1. VCT vs HD CCTA Exam 92% Dose Reduction James P Earls MD Fairfax Radiological Consultants, Fairfax VA Inova Fairfax Hospital, Falls Church VA

2. History 53 yr old male –Had chest pain 2 years ago –Echo, ECG and nuclear stress study all negative CCTA 2006 –retrospectively gated study on VCT system –showed 90% LAD –Cath confirmed; 5.0 mm bare metal stent placed CCTA 2009 –Some recurrent CP several months ago –Prospectively gated, ASIR reconstruction on HD system –No evidence of restenosis

3. Scan Techniques GE HD CT750 Scan parameters –Prospective gating –0 msec padding –30% Volume ASIR –High Res mode –350 mA, kV 120 Contrast –80 cc Visipaque @ 5.5 cc/sec Radiation Dose –CTDI vol 8.22 mGy –DLP 115 mGy-cm –Effective dose 1.61 mSv GE VCT Scan parameters –Retrospective gating –ECG modulation –717 mA, kV 120 Contrast –80 cc Visipaque @ 5.5 cc/sec Radiation Dose –CTDI vol 78.6 mGy –DLP 1419 mGy-cm –Effective dose 19.8 mSv 92% Dose Reduction!!!

4. Whole Heart View VCT Exam 8/2006HD Exam 2/2009

5. Tree VR View VCT Exam 8/2006HD Exam 2/2009

6. MIP View VCT Exam 8/2006HD Exam 2/2009

7. LAD VCT Exam 8/2006HD Exam 2/2009

8. LAD VCT Exam 8/2006HD Exam 2/2009

9. Cath Views Pre-StentPost-Stent

10. Cath Views VCT (8/2006)Cath (8/2006)

11. Cath Views HD study (2/2009)Post-Stent (8/2006)

12. CCTA on the HD