Comparison of radiation-induced DNA damage between conventional and computed tomography coronary angiography
Genotoxicity and angiographic radiation
Keywords:Angiography, chromosome aberration test, ionizing radiation, genotoxicity
Objective: Conventional coronary angiography (CCA) and coronary computed tomography angiography (CCTA) are the most frequently used imaging modalities to diagnose coronary artery disease (CAD). The amount of radiation and genotoxic damage of these imaging methods showed variation with the improved technology. Thus we sought to compare the ionizing radiation doses and radiation-induced DNA damage in patients who were performed CCA and CCTA.
Methods: A total of 76 patients (39 in CCA group, 37 in CCTA group) were enrolled. Patients undergoing CCTA were grouped according to the use of the flash technique (22 patients with CCTA-flash, 15 patients with CCTA-other). The effective radiation dose was recorded. Genotoxicity was compared with the chromosome aberration tests before and after imaging methods.
Results: There was a significant difference between the groups in effective radiation doses given to patients. Radiation was lowest in the CCTA-flash group, followed by CCA, and non-flash CCTA group. There was no change in chromosome aberration rate after CCTA-flash group (p= 0.479). There was a significant increase in chromosome aberration rates after CCA and CCTA-other groups (CCA: p= 0.001; CCTA-other: p= 0.01).
Conclusion: CCTA taken with flash technique in dual-energy CT devices delivers lower dose radiation than other groups. Due to this significant difference, radiation-induced genetic damage was significantly less in patients with CCTA undergoing flash technique.
Gao D, Ning N, Guo Y, Ning W, Niu X, Yang J. Computed tomography for detecting coronary artery plaques: a meta-analysis. Atherosclerosis. 2011; 219(2):603-9.
Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics--2011 update: a report from the American Heart Association. Circulation. 2011; 123(4):e18-e209.
Mangla A, Oliveros E, Williams KA, Kalra DK. Cardiac Imaging in the Diagnosis of Coronary Artery Disease. Curr Probl Cardiol 2017; 42(10):316-66.
Sun Z, Lin C, Davidson R, Dong C, Liao Y. Diagnostic value of 64-slice CT angiography in coronary artery disease: a systematic review. Eur J Radiol 2008; 67(1):78-84.
Sahinarslan A, Erbas G, Kocaman SA, Bas D, Akyel A, Karaer D, et al. Comparison of radiation-induced damage between CT angiography and conventional coronary angiography. Acta Cardiol 2013; 68(3):291-97.
Taylor AJ, Cerqueira M, Hodgson JM, Mark D, Min J, O'Gara P, et al. ACCF/SCCT/ ACR/AHA/ASE/ASNC/ NASCI/SCAI/SCMR 2010 appropriate use criteria for cardiac computed tomography. A report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance. J Am Coll Cardiol 2010; 56(22):1864-94.
Budoff MJ, Dowe D, Jollis JG, Gitter M, Sutherland J, Halamert E, et al. Diagnostic Performance of 64-Multidetector Row Coronary Computed Tomographic Angiography for Evaluation of Coronary Artery Stenosis in Individuals Without Known Coronary Artery Disease: Results From the Prospective Multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) Trial. J Am Coll Cardiol 2008; 52(21):1724-32.
Eren S, Bayram E, Fil F, Koplay M, Sirvanci M, Duran C, et al. An investigation of the association between coronary artery dominance and coronary artery variations with coronary arterial disease by multidetector computed tomographic coronary angiography. J Comput Assist Tomogr 2008; 32(6):929-33.
Sun Z, Jiang W. Diagnostic value of multislice computed tomography angiography in coronary artery disease: a meta-analysis. Eur J Radiol 2006; 60(2):279-86.
Zhang JJ, Liu T, Feng Y, Wu WF, Mou CY, Zhai LH. Diagnostic Value of 64-Slice Dual-Source CT Coronary Angiography in Patients with Atrial Fibrillation: Comparison with Invasive Coronary Angiography. Korean J Radiol 2011; 12(4):416-23.
Achenbach S, Marwan M, Ropers D, Schepis T, Pflederer T, Anders K, et al. Coronary computed tomography angiography with a consistent dose below 1 mSv using prospectively electrocardiogram-triggered high-pitch spiral acquisition. Eur Heart J 2010; 31(3):340-46.
Görmeli CA, Kahraman AS, Özdemir ZM, Yağmur J, Özdemir R, Çolak NAC. Radiation dose comparison between prospectively ECG-triggered and retrospectively ECG-gated techniques of coronary computed tomography angiography on 256-slice dual source CT scanner. J Turgut Ozal Med Cent 2016; 23(2):181-4.
Sommer WH, Albrecht E, Bamberg F, Schenzle JC, Johnson TR, Neumaier K, et al. Feasibility and radiation dose of high-pitch acquisition protocols in patients undergoing dual-source cardiac CT. AJR 2010; 195(6):1306-12.
Cardis E, Vrijheid M, Blettner M, Gilbert E, Hakama M, Hill C, et al. The 15-Country Collaborative Study of Cancer Risk among Radiation Workers in the Nuclear Industry: estimates of radiation-related cancer risks. Radiat Res 2007; 167(4):396-416.
Tucker JD. Sensitivity, specificity, and persistence of chromosome translocations for radiation biodosimetry. Military Medicine 2002; 167(2 Suppl):8-9.
Sekeroğlu ZA, Şekeroğlu V. Genetik toksisite testleri. TÜBAV Bilim Dergisi. 2011; 4(3):221-9.
Zeiger E. Identification of rodent carcinogens and noncarcinogens using genetic toxicity tests: premises, promises, and performance. Regul Toxicol Pharmacol 1998; 28(2):85-95.
Agrawala PK, Adhikari JS, Chaudhury NK. Lymphocyte chromosomal aberration assay in radiation biodosimetry. J Pharm Bioallied Sci 2010; 2(3):197-201.
Murray CJ, Lopez AD. Global mortality, disability, and the contribution of risk factors: Global Burden of Disease Study. Lancet 1997; 349(9063):1436-42.
Kopp AF, Schroeder S, Kuettner A, Baumbach A, Georg C, Kuzo R, et al. Non-invasive coronary angiography with high resolution multidetector-row computed tomography. Results in 102 patients. Eur Heart J 2002; 23(21):1714-25.
Nieman K, Rensing BJ, van Geuns RJ, Munne A, Ligthart JM, Pattynama PM, et al. Usefulness of multislice computed tomography for detecting obstructive coronary artery disease. Am J Cardiol 2002; 89(8):913-18.
Knuuti J, Wijns W, Saraste A, Capodanno D, Barbato E, Funck-Brentano C, et al. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes: The Task Force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC). Eur Heart J 2020; 41: 407-77.
Einstein AJ. Radiation Dose Reduction in Coronary CT Angiography. Time to Buckle Down. JACC: Cardiovascular Imaging 2015; 8(8):897-99.
Coles DR, Smail MA, Negus IS, Wilde P, Oberhoff M, Karsch KR, et al. Comparison of radiation doses from multislice computed tomography coronary angiography and conventional diagnostic angiography. J Am Coll Cardiol 2006; 47(9):1840-45.
Popp HD, Meyer M, Brendel S, Prinzhorn W, Naumann N, Weiss C, et al. Leukocyte DNA damage after reduced and conventional absorbed radiation doses using 3rd generation dual-source CT technology. Eur J Radiol Open 2016;3:134-7.
Karcaaltincaba M, Aktas A. Dual-energy CT revisited with multidetector CT: review of principles and clinical applications. Diagn Interv Radiol 2011;17(3):181-94.
Koplay M, Erdogan H, Avci A, Sivri M, Demir K, Guler I, et al. Radiation dose and diagnostic accuracy of high-pitch dual-source coronary angiography in the evaluation of coronary artery stenoses. Diagn Interv Imaging 2016; 97(4):461-69.
Smettei OA, Sayed S, M Al Habib A, Alharbi F, Abazid RM. Ultra-fast, low dose high-pitch (FLASH) versus prospectively-gated coronary computed tomography angiography: Comparison of image quality and patient radiation exposure. J Saudi Heart Assoc 2018; 30(3): 165–71.
Vijayalakshmi K, Kelly D, Chapple C‐ L, Williams D, Wright R, Stewart MJ, et al. Cardiac catheterisation: radiation doses and lifetime risk of malignancy. Heart 2007; 93(3):370-71.
Kuefner MA, Grudzenski S, Hamann J, Achenbach S, Lell M, Anders K, et al. Effect of CT scan protocols on x-ray-induced DNA double-strand breaks in blood lymphocytes of patients undergoing coronary CT angiography. Eur Radiol 2010; 20(12):2917-24.
Kuefner MA, Hinkmann FM, Alibek S, Azoulay S, Anders K, Kalender WA, et al. Reduction of X-ray induced DNA double-strand breaks in blood lymphocytes during coronary CT angiography using high-pitch spiral data acquisition with prospective ECG-triggering. Invest Radiol 2010; 45(4):182-7.
Forni A. Comparison of chromosome aberrations and micronuclei in testing genotoxicity in humans. Toxicology Letters. 1994; 72(1-3):185-90.
Manna C, Silva M, Cobelli R, Poggesi S, Rossi C, Sverzellati N. High-pitch dual-source CT angiography without ECG-gating for imaging the whole aorta: intraindividual comparison with standard pitch single-source technique without ECG gating. Diagn Interv Radiol. 2017;23(4):293-99.
Yamasaki Y, Kamitani T, Sagiyama K, Matsuura Y, Hida T, Nagata H. Model-based iterative reconstruction for 320-detector row CT angiography reduces radiation exposure in infants with complex congenital heart disease. Diagn Interv Radiol 2021; 27(1):42-9.
How to Cite
Copyright (c) 2023 The Injector
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.