Deep learning–based scan range optimization can reduce radiation exposure in coronary CT angiography

Objectives Cardiac computed tomography (CT) is essential in diagnosing coronary heart disease. However, a disadvantage is the associated radiation exposure to the patient which depends in part on the scan range. This study aimed to develop a deep neural network to optimize the delimitation of scan ranges in CT localizers to reduce the radiation dose. Methods On a retrospective training cohort of 1507 CT localizers randomly selected from calcium scoring and angiography scans and acquired between 2010 and 2017, optimized scan ranges were delimited by two radiologists in consensus. A neural network was trained to reproduce the scan ranges and was tested on two randomly selected and independent validation cohorts: an internal cohort of 233 CT localizers (January 2018–June 2020) and an external cohort from a nearby hospital of 298 CT localizers (July 2020–December 2020). Localizers where a bypass surgery was visible were excluded. The effective radiation dose to the patient was simulated using a Monte Carlo simulation. Scan ranges of radiographers, radiologists, and the network were compared using an equivalence test; likewise, the reduction in effective dose was tested using a superior test. Results The network replicated the radiologists’ scan ranges with a Dice score of 96.5 ± 0.02 ( p < 0.001, indicating equivalence). The generated scan ranges resulted in an effective dose reduction of 10.0% ( p = 0.002) in the internal cohort and 12.6% ( p < 0.001) in the external cohort compared to the scan ranges delimited by radiographers in clinical routine. Conclusions Automatic delimitation of the scan range can result in a radiation dose reduction to the patient. Clinical relevance statement Fully automated delimitation of the scan range using a deep neural network enables a significant reduction in radiation exposure during CT coronary angiography compared to manual examination planning. It can also reduce the workload of the radiographers. Key Points • Scan range delimitation for coronary computed tomography angiography could be performed with high accuracy by a deep neural network. • Automated scan ranges showed a high agreement of 96.5% with the scan ranges of radiologists. • Using a Monte Carlo simulation, automated scan ranges reduced the effective dose to the patient by up to 12.6% (0.9 mSv) compared to the scan ranges of radiographers in clinical routine. Graphical abstract