Coronary artery calcium detection & quantification with current and next-generation CT: It is time for a change

The overall aims of this thesis, entitled ‘Coronary artery calcium detection & quantification with current and next-generation CT’, are to better understand spurious variations in coronary artery calcium (CAC) scoring and to provide strategies to address this problem. To better understand sources of variation we investigated the extent to which differences in CAC scores are attributable to the type of CT system, patient size and heart rate, level of radiation dose reduction, iterative reconstruction (IR), deep-learning reconstruction (DLR), calcium-aware reconstruction kernel, slice thickness, CAC scoring algorithms, and CT detector technology, rather than true variations in the amount of CAC. Importantly, we demonstrate that technical advances in CT can improve clinical CAC scoring, by reducing CAC scoring variability and/or reducing patient radiation dose.