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PLoS One. 2018 Jan 5;13(1):e0190584. doi: 10.1371/journal.pone.0190584. eCollection 2018.

Effectiveness of automatic tube potential selection with tube current modulation in coronary CT angiography for obese patients: Comparison with a body mass index-based protocol using the propensity score matching method.

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Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Korea.



Reduced image quality from increased X-ray scatter and image noise can be problematic when coronary computed tomography angiography (CCTA) imaging is performed in obese patients. The aim of this study was to compare the image quality and radiation dose obtained using automatic tube potential selection with tube current modulation (APSCM) with those obtained using a body mass index (BMI)-based protocol for CCTA in obese patients.


A total of 203 consecutive obese (BMI > 30 kg/m2) patients were retrospectively enrolled, of whom 96 underwent CCTA with APSCM and 107 underwent a BMI-based protocol. After applying the propensity score matching method, the clinical parameters, subjective and objective image quality, and radiation dose were compared between the APSCM group and the matched BMI-based group. These parameters were also compared among different tube potential subgroups.


No significant differences were observed between the APSCM group and the BMI-based group with respect to image quality or radiation dose assessment (p > 0.05). Twenty patients (21%) examined with 140 kV in the APSCM group were exposed to significantly more radiation (p < 0.05) than patients in the BMI-based group or patients in the other APSCM kV subgroups; significant improvement in image quality was not observed in the 140 kV subgroup. Patients with a high BMI and a large effective diameter tended to be examined with 140 kV (p < 0.05).


The use of APSCM for CCTA in obese patients did not significantly reduce the radiation dose or improve image quality compared with those in the matched BMI-based group. Our data indicate that it is better to avoid using APSCM when 140 kV is automatically selected, due to increased radiation dose and lack of significant improvement in image quality.

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