Introduction
The coronary CT calcium scan is a valuable non-invasive tool for the cardiologist, who often will use the calcium (Ca) score to determine if a patient needs to pursue further clinical evaluation and therapy. The acquired ECG-gated CT images visualize calcifications in the coronary vessels, while dedicated software automates the quantification and generates a report.
Coronary calcium deposit variations suggest significant narrowing in the coronary arteries and may be an indication for further clinical evaluations to prevent a future heart attack. A special CT scan called a Coronary Artery Calcium. Scoring CT measures the amount of calcium and provides patients with their coronary artery calcium score. That score is proven to quantify the patient’s risk of heart attack or stroke in the next 5-10 years. The higher the calcium score, the higher the risk of a future cardiac event, while patients with a score of zero have an extremely low risk of developing coronary disease.
CT-guided calcium scoring is a reproducible and accurate method to quantify the calcified plaque burden. The total calcium (Ca) score is an established surrogate of overall coronary plaque burden, most commonly quantified according to the Agatston score, and can determine if vessels are blocked or narrowed by the buildup of plaque. More recently, novel technology like tin filter with any KV calcium scoring technology allows high-quality CT calcium scoring scans at a minimum dose level to the patient, further validating it as a screening tool.
The coronary CT calcium scan is a valuable non-invasive tool for the cardiologist, who often will use the calcium (Ca) score to determine if a patient needs to pursue further clinical evaluation and therapy. The acquired ECG-gated CT images visualize calcifications in the coronary vessels, while dedicated software automates the quantification and generates a report.
Coronary calcium deposit variations suggest significant narrowing in the coronary arteries and may be an indication for further clinical evaluations to prevent a future heart attack. A special CT scan called a Coronary Artery Calcium. Scoring CT measures the amount of calcium and provides patients with their coronary artery calcium score. That score is proven to quantify the patient’s risk of heart attack or stroke in the next 5-10 years. The higher the calcium score, the higher the risk of a future cardiac event, while patients with a score of zero have an extremely low risk of developing coronary disease.
CT-guided calcium scoring is a reproducible and accurate method to quantify the calcified plaque burden. The total calcium (Ca) score is an established surrogate of overall coronary plaque burden, most commonly quantified according to the Agatston score, and can determine if vessels are blocked or narrowed by the buildup of plaque. More recently, novel technology like tin filter with any KV calcium scoring technology allows high-quality CT calcium scoring scans at a minimum dose level to the patient, further validating it as a screening tool.
The coronary CT calcium scan is a valuable non-invasive tool for the cardiologist, who often will use the calcium (Ca) score to determine if a patient needs to pursue further clinical evaluation and therapy. The acquired ECG-gated CT images visualize calcifications in the coronary vessels, while dedicated software automates the quantification and generates a report.
Scanning technique
Finally, an AI-based PACS-ready automatic calcium (Ca) score algorithm produces individual vessel scores along with a comprehensive calcium (Ca) score report without any human interference. This helps clinicians to evaluate the calcium scoring quickly without using an additional workstation.
All patients have been scanned on the Siemens Healthineers SOMATOM go.All CT scanner, equipped with state-of-the-art AI-based advanced cardiac imaging, including the adaptive perspective acquisition (CorAdSeq) with tin filter for ultra-low-dose imaging. SOMATOM go. All systems provide access to the novel “Any kV CaScoring” technique that further reduces the dose delivered, optimizing it by patient size. The traditional Agatston score restricts the user to the 120 kV setting, dramatically increasing the dose delivered for most body types whereas the “Any kV CaScoring” enables choosing the optimal kV setting for each patient, where a specific reconstruction kernel (Sa36) is applied to allow performing the Agatston equivalent low-dose calcium (Ca) scores.
Automatic exposure control for kV and mAs settings support the operator in reducing the patient dose (CARE Dose4D, CARE kV, and Flex Padding). In addition, the integrated SAFIRE iterative reconstruction algorithm reduces image noise, generating superior image quality.
Finally, an AI-based PACS-ready automatic calcium (Ca) score algorithm produces individual vessel scores along with a comprehensive calcium (Ca) score report without any human interference. This helps clinicians to evaluate the calcium scoring quickly without using an additional workstation.
All patients have been scanned on the Siemens Healthineers SOMATOM go.All CT scanner, equipped with state-of-the-art AI-based advanced cardiac imaging, including the adaptive perspective acquisition (CorAdSeq) with tin filter for ultra-low-dose imaging. SOMATOM go. All systems provide access to the novel “Any kV CaScoring” technique that further reduces the dose delivered, optimizing it by patient size. The traditional Agatston score restricts the user to the 120 kV setting, dramatically increasing the dose delivered for most body types whereas the “Any kV CaScoring” enables choosing the optimal kV setting for each patient, where a specific reconstruction kernel (Sa36) is applied to allow performing the Agatston equivalent low-dose calcium (Ca) scores.
Automatic exposure control for kV and mAs settings support the operator in reducing the patient dose (CARE Dose4D, CARE kV, and Flex Padding). In addition, the integrated SAFIRE iterative reconstruction algorithm reduces image noise, generating superior image quality.
Finally, an AI-based PACS-ready automatic calcium (Ca) score algorithm produces individual vessel scores along with a comprehensive calcium (Ca) score report without any human interference. This helps clinicians to evaluate the calcium scoring quickly without using an additional workstation.
Case Study 1
Moderate calcium (Ca) score
A 70-year-old male patient presented with a history of hypertension, hyperlipidemia, and smoking. Calcium (Ca) score demonstrates a moderate calcified lesion in the LAD and RCA.
Total Agaston score 287.9.Any kV calcium scoring protocol – Image parameter - 90 kV with 40 mAs with CareDose4D and Care KV .total scan length 17.7 cm, CTDI Vol-2.12 (mGy), DLP 37.17 mGy-cm, Effective dose 0.52 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total Agaston score 287.9.Any kV calcium scoring protocol – Image parameter - 90 kV with 40 mAs with CareDose4D and Care KV .total scan length 17.7 cm, CTDI Vol-2.12 (mGy), DLP 37.17 mGy-cm, Effective dose 0.52 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total Agaston score 287.9.Any kV calcium scoring protocol – Image parameter - 90 kV with 40 mAs with CareDose4D and Care KV .total scan length 17.7 cm, CTDI Vol-2.12 (mGy), DLP 37.17 mGy-cm, Effective dose 0.52 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total Agaston score 287.9.Any kV calcium scoring protocol – Image parameter - 90 kV with 40 mAs with CareDose4D and Care KV .total scan length 17.7 cm, CTDI Vol-2.12 (mGy), DLP 37.17 mGy-cm, Effective dose 0.52 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total Agaston score 287.9.Any kV calcium scoring protocol – Image parameter - 90 kV with 40 mAs with CareDose4D and Care KV .total scan length 17.7 cm, CTDI Vol-2.12 (mGy), DLP 37.17 mGy-cm, Effective dose 0.52 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total Agaston score 287.9.Any kV calcium scoring protocol – Image parameter - 90 kV with 40 mAs with CareDose4D and Care KV .total scan length 17.7 cm, CTDI Vol-2.12 (mGy), DLP 37.17 mGy-cm, Effective dose 0.52 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total Agaston score 287.9.Any kV calcium scoring protocol – Image parameter - 90 kV with 40 mAs with CareDose4D and Care KV .total scan length 17.7 cm, CTDI Vol-2.12 (mGy), DLP 37.17 mGy-cm, Effective dose 0.52 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Case Study 2
Mild calcium (Ca) score
A 62-year-old male patient presented with a history of hypertension and diabetes. CT calcium (Ca) scoring reveals a mild calcified lesion in the LM, LAD, and RCA.
Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Case Study 3
Calcium (Ca) Zero score
A 32-year-old male patient presented with a history of mild chest pain and smoking. CT calcium (Ca) scoring reveals a zero calcium (Ca) score.
Total agaston score 124.2 Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total agaston score 124.2 Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total agaston score 124.2 Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total agaston score 124.2 Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total agaston score 124.2 Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total agaston score 124.2 Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Total agaston score 124.2 Any kV calcium scoring protocol – Image parameter - 90 kV & 40 mAs with CareDose4D and Care KV. Total scan length 15.59 cm, CTDI Vol- 4.13 (mGy), DLP 64.38 mGy-cm, Effective dose 0.9 msv, a conversion factor of 0.014 mSv·mGy−1·cm−1.
Conclusion
Coronary artery calcium scoring is a sensitive marker of atherosclerosis that can be quantified using non-contrast CT evaluation. The resulting calcium score can suggest further clinical evaluation, leading to improved patient outcomes. In addition, ultra-low dose techniques enable calcium score screening and safe calcium scoring follow-ups.
An extremely low-dose coronary calcium (Ca) scoring CT technique that does not require the use of a contrast agent enables safe and widespread screening and preventive cardiac evaluation. This is reflected by a growing number of countrywide screening initiatives across the world.Identifying high-risk, asymptomatic patients remains the hurdle of cardiovascular disease prevention.
Coronary artery calcium scoring is a sensitive marker of atherosclerosis that can be quantified using non-contrast CT evaluation. The resulting calcium score can suggest further clinical evaluation, leading to improved patient outcomes. In addition, ultra-low dose techniques enable calcium score screening and safe calcium scoring follow-ups.
An extremely low-dose coronary calcium (Ca) scoring CT technique that does not require the use of a contrast agent enables safe and widespread screening and preventive cardiac evaluation. This is reflected by a growing number of countrywide screening initiatives across the world.Identifying high-risk, asymptomatic patients remains the hurdle of cardiovascular disease prevention.
Coronary artery calcium scoring is a sensitive marker of atherosclerosis that can be quantified using non-contrast CT evaluation. The resulting calcium score can suggest further clinical evaluation, leading to improved patient outcomes. In addition, ultra-low dose techniques enable calcium score screening and safe calcium scoring follow-ups.