CT dose management for neurologic events in patients with cardiac devices: Radiation exposure variation in patients with cardiac devices

PURPOSE We aimed to compare the inter-center cranial computed tomography (CT) acquisition rates, CT findings, CT-related radiation dose, and variability of CT acquisition parameters for neurologic events among patients with implantable cardioverter-defibrillator (ICD) or left ventricular assist device (LVAD). METHODS A total of 224 patients (ICD group, n=155; LVAD group, n=69) who had at least one cranial CT scan were enrolled from 3 medical centers (Centers A, B, and C). The variability and effect of the number, indication, and findings of cranial CT scans as well as CT acquisition parameters including tube potential (kV), tube current (mAs), tube rotation time, slice collimation, and spiral or sequential scanning techniques on CT dose index volume (CTDIvol), and total dose length product (DLP) were analyzed. RESULTS The mean DLP value of Center A and the mean CTDIvol values of Centers A and C were significantly lower than those of Center B (P<.001). The mean CTDIvol and DLP values in the ICD group were substantially lower than in the LVAD group (P<.001). The most potent parameters causing the changes in CTDIvol and DLP were kV, mAs values, and the CT scanning technique (sequential or spiral), according to multivariate linear regression analysis. CONCLUSION Cranial CT acquisition parameters and radiation doses vary significantly between centers, which necessitates optimization of cranial CT protocols to overcome the cumulative radiation dose burden in patients with neurologic events.