Аорта

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798.Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Engl J Med. 2006;355:1903–11.

799.Miyairi T, Takamoto S, Kotsuka Y, et al. Comparison of neurocognitive results after coronary artery bypass grafting and thoracic aortic surgery using retrograde cerebral perfusion. Eur J Cardiothorac Surg. 2005;28: 97–101.

800.Eagle KA, Isselbacher EM, DeSanctis RW. Cocaine-related aortic dissection in perspective. Circulation. 2002;105:1529 –30.

801.Maron BJ, Chaitman BR, Ackerman MJ, et al. Recommendations for physical activity and recreational sports participation for young patients with genetic cardiovascular diseases. Circulation. 2004;109:2807–16.

802.Williams MA, Haskell WL, Ades PA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116:572– 84.

803.Palatini P, Mos L, Munari L, et al. Blood pressure changes during heavy-resistance exercise. J Hypertens Suppl. 1989;7:S72–S73.

804.Hatzaras I, Tranquilli M, Coady M, et al. Weight lifting and aortic dissection: more evidence for a connection. Cardiology. 2007;107: 103– 6.

805.Nataf P, Lansac E. Dilation of the thoracic aorta: medical and surgical management. Heart. 2006;92:1345–52.

806.Elefteriades JA, Hatzaras I, Tranquilli MA, et al. Weight lifting and rupture of silent aortic aneurysms. JAMA. 2003;290:2803.

807.Williams OD. Quality of care versus provider volume: does one lead to the other? Med Care. 2003;41:1127– 8.

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809.Schermerhorn ML, Giles KA, Hamdan AD, et al. Population-based outcomes of open descending thoracic aortic aneurysm repair. J Vasc Surg. 2008.

810.Norgren L, Larzon T. Endovascular repair of the ruptured abdominal aortic aneurysm. Scand J Surg. 2008;97:178 – 81.

811.Troeng T. Volume versus outcome when treating abdominal aortic aneurysm electively: is there evidence to centralise? Scand J Surg. 2008;97:154 –9.

811a.Bonow RO, Masoudi FA, Rumsfeld JS, et al. ACC/AHA classification of care metrics: performance measures and quality metrics: a report of the American College of Cardiology/American Heart Assocation Task Force on Performance Measures. J Am Coll Cardiol. 2008;52:2113–7.

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821.Kosseim M, Mayo NE, Scott S, et al. Ranking hospitals according to acute myocardial infarction mortality: should transfers be included? Med Care. 2006;44:664 –70.

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826.Toda R, Moriyama Y, Masuda H, et al. Organ malperfusion in acute aortic dissection. Jpn J Thorac Cardiovasc Surg. 2000;48:545–50.

827.Dietz H, Deveraux R, Loeys BL. NHLBI working group research in Marfan syndrome and related disorders. Available at: Available at: http://www.nhlbi.nih.gov/meetings/workshops/marfan20070430.htm. Accessed January 7, 2010.

KEY WORDS: ACC/AHA Clinical Practice Guideline thoracic aortic diseasethoracic aortic dissection thoracic aortic aneurysm intramural hematoma genetic syndromes associated with thoracic aortic aneurysmemergency department acute thoracic aortic disease presentation and evaluation

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Appendix 1. Author Relationships With Industry and Other Entities—2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

				Ownership/		Institutional,
Committee				Partnership/		Organizational or Other
Member	Employment	Consultant	Speaker	Principal	Research	Financial Benefit	Expert Witness
Loren F.	Cardiac, Vascular & Thoracic	None	None	None	None	None	● 2007; Defense;
Hiratzka,	Surgeons Inc. and TriHealth						Aortic Dissection
Chair	Inc.—Medical Director,
	Cardiac Surgery
George L.	University of Chicago	● Abbott	● Forest Laboratories	None	● Forest Laboratories	None	None
Bakris	Medical Center—Professor	● Boehringer Ingelheim	● GlaxoSmithKline		● GlaxoSmithKline
	of Medicine; Director,	● Bristol-Myers	● Merck		● Myogen
	Hypertension Center	Squibb/Sanofi-	● Novartis		● National Institutes
		aventis			of Health (NIDDK/
		● Forest Laboratories			NHLBI)
		● GlaxoSmithKline
		● Merck
Joshua A.	Brigham & Women’s	● Bristol-Myers Squibb	● Bristol-Myers	None	None	None	None
Beckman	Hospital—Director,	● Sanofi-aventis	Squibb
	Cardiovascular Fellows		● GlaxoSmithKline
	Program		● Merck
			● Sanofi-aventis
Robert M.	Seattle Cardiology—Director,	● Abbott Vascular	● Boston Scientific	● Vascular	● Boston Scientific	● Boston Scientific	● Expert witness in
Bersin	Endovascular Services &	● Boston Scientific	● Bristol-Myers	Solutions		● Cordis Endovascular	a case involving
	Clinical Research	● Bristol-Myers Squibb	Squibb			● Vascular Solutions	iatrogenic type B
		● Cordis Endovascular	● Daiichi Sankyo				dissection
		● Eli Lilly	● Eli Lilly
		● EV3	● Sanofi-aventis
		● Revascular	● The Medicines
		● Theraputics	Company
		● Sanfoi-aventis
		● Vascular Solution
		● W.L. Gore
Vincent F.	Uniformed Services	None	None	None	None	None	None
Carr	University of Health
	Science—Professor of
	Medicine
Donald E.	Atlantic Health—Vice	None	None	None	None	None	None
Casey, Jr	President of Quality & Chief
	Medical Officer; Associate
	Professor of Medicine,
	Mount Sinai School of
	Medicine
Kim A.	University of Michigan Health	● NHLBI	None	None	● Blue Cross/Blue	None	None
Eagle	System—Albion Walter	● Robert Wood			Shield
	Professor of Internal	Johnson Foundation			● Bristol-Myers
	Medicine; Clinical Director,	● Sanofi-aventis			Squibb
	Cardiovascular Center				● National Institutes
					of Health
					● Pfizer
Luke K.	Mount Sinai Medical	None	None	None	None	None	None
Hermann	Center—Assistant Professor
	of Emergency Medicine;
	Director, Chest Pain Unit
Eric M.	Massachusetts General	None	None	None	None	None	● 2007; Plantiff;
Isselbacher	Hospital—Associate						Aortic Dissection
	Professor of Medicine,
	Harvard Medical School;
	Co-Director, Thoracic Aortic
	Center
Ella A.	University of Michigan Health	● GE Healthcare	None	None	None	● GERRAF (GE	None
Kazerooni	System—Professor of	● Vital Images				Radiology Research
	Medicine; Director,					Fellowship)
	Cardiothoracic Radiology
Nicholas T.	Missouri Baptist Medical	● Edwards Lifesciences	None	None	None	None	● 2006; Defense;
Kouchoukos	Center—Cardiovascular						Aortic Dissection
	Surgeon
							(Continued)

e366	Circulation	April 6, 2010
Appendix 1. Continued
					Ownership/		Institutional,
Committee					Partnership/		Organizational or Other
Member	Employment		Consultant	Speaker	Principal	Research	Financial Benefit	Expert Witness
Bruce W.	The Cleveland Clinic—Chair,		None	None	None	None	None	None
Lytle	Heart and Vascular Institute
Dianna M.	University of Texas		None	None	None	● Doris Duke	None	None
Milewicz	Southwestern Medical					Foundation
	Center—President George					● Genetech
	H.W. Bush Chair in					● National Institutes
	Cardiovascular Medicine;					of Health
	Professor & Director,					● Vivian Smith
	Division of Medical Genetics					Foundation
David L.	Mount Sinai Medical		None	None	None	None	None	None
Reich	Center—Professor & Chair,
	Department of
	Anesthesiology
Souvik Sen	University of South Carolina		● Coaxia	● Boehringer	None	● American Heart	None	None
	School of		● Bristol-Myers Squibb	Ingelheim		Association
	Medicine–Professor and		● Pfizer			● Genetech
	Chair, Department of		● Sanofi-aventis			● Sanofi-aventis
	Neurology
Julie A.	Stanford University School of		None	None	None	None	None	None
Shinn	Medicine—Cardiovascular
	Clinical Nurse Specialist
Lars G.	The Cleveland		None	None	None	● Edwards	None	None
Svensson	Clinic—Director, The Center					Lifesciences
	for Aortic Surgery; Director,					● Evalve
	Marfan Syndrome and
	Collective Tissue Disorder
	Clinic
David M.	University of Michigan Health		● W.L. Gore	None	None	● W.L. Gore	None	● 2000; Defense;
Williams	System—Professor,					● Medtronic		Failure to
	Department of Radiology;							diagnose and
	Director, Interventional							treat mesenteric
	Radiology							ischemia with
								aortic dissection

● 2009; Defense; Failure to diagnose and treat mesenteric ischemia with aortic dissection

NHLBI indicates National Heart, Lung, and Blood Institute; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases.

This table represents the relevant relationships of committee members with industry and other entities that were reported orally at the initial writing committee meeting and updated in conjunction with all meetings and conference calls of the writing committee during the document development process. It does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of 5% or more of the voting stock or share of the business entity, or ownership of $10 000 or more of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. A relationship is considered to be modest if it is less than significant under the preceding definition. Relationships noted in this table are modest unless otherwise noted.

*Significant (greater than $10 000) relationship.

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Appendix 2. Reviewer Relationships With Industry and Other Entities—2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease

				Ownership/		Institutional,
Peer				Partnership/		Organizational or Other
Reviewer	Representation	Consultant	Speaker	Principal	Research	Financial Benefit	Expert Witness
Amjad	Official Reviewer—Society	None	None	None	None	None	None
Almahameed	for Vascular Medicine
Richard A.	Official Reviewer—American	None	None	None	None	None	None
Bernstein	Stroke Association
Christopher	Official	None	None	None	None	None	None
E. Buller	Reviewer—ACCF/AHA Task
	Force Lead Reviewer
Albert T.	Official Reviewer—Society of	● EKR Therapeutics	● EKR Therapeutics	None	● The Medicines	None	None
Cheung	Cardiovascular	● The Medicines	● The Medicines		Company*
	Anesthesiologists	Company	Company		● Neuralstem*
		● Neuralstem	● PDL Biopharm		● PDL Biopharm*
		● Schering Plough
Michael D.	Official Reviewer—Society of	● W.L. Gore*	● Cook	None	● Cook	None	None
Dake	Interventional Radiologists	● Medtronic			● W.L. Gore*
					● Medtronic
Antionette S.	Official Reviewer—AHA	None	None	None	None	None	None
Gomes	Cardiovascular Surgery and
	Anesthesia Committee
Robert A.	Official Reviewer—ACCF	● Medtronic	None	None	None	None	None
Guyton	Board of Trustees
Clifford J.	Official Reviewer—Society	None	None	None	● Possis Corp.	None	None
Kavinsky	for Cardiovascular
	Angiography and
	Interventions
Scott Kinlay	Official Reviewer—Society	None	● Merck	None	● Pfizer	None	None
	for Vascular Medicine		● Pfizer
Richard J.	Official Reviewer—ACCF	None	None	None	None	None	None
Kovacs	Board of Govenors
Christine	Official Reviewer—Society of	None	None	None	None	None	None
Mora	Cardiovascular
Mangano	Anesthesiologists
Steven R.	Official Reviewer—American	None	● Boehringer	None	● American Heart	None	None
Messé	Stroke Association		Ingelheim		Association*
Eric Roselli	Official Reviewer—Society of	● Medtronic	None	None	● Cook	None	None
	Thoracic Surgeons	● Vascutek
Geoff D.	Official Reviewer—American	● Fovia	● Bracco	● TeraRecon	● Biosense-Webster*	None	None
Rubin	College of Radiology
Frank J.	Official Reviewer—American	● Bracco	● Bracco	● Siemens	● Bracco	None	None
Rybicki	College of Radiology	● Siemens Medical	● Siemens Medical	Medical	● Toshiba Medical
		● Toshiba Medical	● Toshiba Medical		Systems*
		Systems*	Systems*
		● Vital Images	● Vital Images
Thoralf M.	Official Reviewer—American	None	None	None	● Bolton Medical	● Atricure	None
Sundt	Association for Thoracic					● Bolton Medical
	Surgery					● Jarvik Heart
						● Medtronic
						● Sorin
						Group/Carbomedics
						● St. Jude Medical
						● Thoratec
						Corporation
						● Ventracor
						● W.L. Gore
Richard D.	Official Reviewer—AHA	None	None	None	None	None	None
White	Peripheral Vascular Disease
	Council
							(Continued)

e368	Circulation	April 6, 2010
Appendix 2. Continued
					Ownership/		Institutional,
Peer					Partnership/		Organizational or Other
Reviewer	Representation		Consultant	Speaker	Principal	Research	Financial Benefit	Expert Witness
James P.	Official Reviewer—Society		● Abbott Vascular	● Abbott Vascular	None	● Abbott Vascular	None	None
Zidar	for Cardiovascular		● Cordis*	● Cordis*		● Cordis*
	Angiography and		● Medtronic Vascular	● Medtronic Vascular		● Medtronic Vascular
	Interventions
Wyatt	Organizational		None	None	None	None	None	None
Decker	Reviewer—American College
	of Emergency Physicians
Josh M.	Organizational		None	None	None	None	None	None
Kosowsky	Reviewer—American College
	of Emergency Physicians
Emile	Organizational		None	None	None	None	None	None
Mohler	Reviewer—American College
	of Physicians
James	Content Reviewer—ACCF		None	None	None	None	None	None
Burke	Catherization Committee
Edward P.	Content Reviewer		None	None	None	None	None	None
Chen
Mark A.	Content		None	None	None	None	None	None
Creager	Reviewer—ACCF/AHA Task
	Force on Practice Guidelines
Jose G. Diez	Content Reviewer—ACCF		● Sanofi-aventis	None	None	None	None	None
	Catherization Committee
John A.	Content Reviewer		● Baxter	None	● Coolspine	● Celera Diagnostics	None	● 2006; Plaintiff;
Elefteriades								Aortic Dissection*
D. Craig	Content Reviewer		● Medtronic	● St. Jude Medical	None	● NHLBI	None	None
Miller						● Stanford PARTNER
						Trial
Rick	Content		None	None	None	None	None	None
Nishimura	Reviewer—ACCF/AHA Task
	Force on Practice Guidelines
Patrick T.	Content Reviewer		None	None	None	None	None	None
O’Gara
Carlos Ruiz	Content Reviewer—ACCF		None	None	None	None	None	None
	Interventional Council

ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; NHLBI, National Heart, Lung, and Blood Institute.

This table represents the relevant relationships with industry and other entities that were disclosed at the time of peer review. It does not necessarily reflect relationships with industry at the time of publication. A person is deemed to have a significant interest in a business if the interest represents ownership of 5% or more of the voting stock or share of the business entity, or ownership of $10 000 or more of the fair market value of the business entity; or if funds received by the person from the business entity exceed 5% of the person’s gross income for the previous year. A relationship is considered to be modest if it is less than significant under the preceding definition. Relationships in this table are modest unless otherwise noted. Names are listed in alphabetical order within each category of review.

*Significant (greater than $10 000) relationship.

Hiratzka et al

Appendix 3. Abbreviation List

AAA abdominal aortic aneurysm

AoD aortic dissection

CAD coronary artery disease

CSF cerebrospinal fluid

CT computed tomographic imaging

ECG electrocardiogram

GCA giant cell arteritis

IMH intramural hematoma

INR international normalized ratio

IRAD International Registry of Acute Aortic Dissection

MEP motor evoked potential

MI myocardial infarction

MMP matrix metalloproteinase

MR magnetic resonance imaging

PAU penetrating atherosclerotic ulcer

SSEP somatosensory evoked potentials

SSFP steady-state free precession

STEMI ST-elevation myocardial infarction

TAA thoracoabdominal aneurysm

TEE transesophageal echocardiogram

TIA transient ischemic attack

TRA traumatic rupture of the aorta

TTE transthoracic echocardiogram

UHC University HealthSystem Consortium

2010 Guidelines on Thoracic Aortic Disease

e369

Correction

In the article by Hiratzka et al, “2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/ SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine,” which published online March 16, 2010, and appeared with the April 6, 2010, issue of the journal (Circulation. 2010;121:e266-e369), several corrections were needed.

1.On page e309, in Section 8.6.2, right column, last paragraph, the first sentence read, “Multidetector CT, TEE, and MR all provide acceptable diagnostic accuracy for the diagnosis of acute AoD.” It should be changed to read, “Multidetector CT with contrast, TEE, and MR all provide acceptable diagnostic accuracy for the diagnosis of acute AoD.”

2.On page e310, in Figure 25, in the step 3 “Risk based diagnostic evaluation” section, T11 “Aortic Imaging Study,” the second bullet read, “CT (Image entire aorta: chest to pelvis).” It should be changed to read, “CT with contrast (Image entire aorta: chest to pelvis).” The revised figure is reproduced in its entirety on the next page.

(Circulation. 2013;128:e177-e178.)

© 2013 American Heart Association, Inc.

Circulation is available at http://circ.ahajournals.org DOI: 10.1161/CIR.0b013e3182a7f655

e177

e178    Circulation    September 10, 2013

STEP 1

Identify patients at risk for acute AoD

STEP 2

Bedside risk assessment

	Consider acute AoD in all patients presenting with:			T1
	• Chest, back, or abdominal pain				Boxes with accompanying text are labeled and
	• Syncope				numbered with the	T	symbol.
	• Symptoms consistent with perfusion deficit
	(i.e. CNS, mesenteric, myocardial, or limb ischemia)
	Focused bedside pre-test risk assessment for acute AoD.				T2
High Risk Conditions	1	High Risk Pain Features	2	High Risk Exam Features	3
		Chest, back, or abdominal		• Evidence of perfusion deficit
	+		+	• Pulse deficit
• Marfan Syndrome		pain described as the
				• Systolic BP differential
• Connective tissue disease		following:
				• Focal neurologic deficit
• Family history aortic disease		• Abrupt in onset/ severe in		(in conjunction with pain)
• Known aortic valve disease
		intensity
• Recent aortic manipulation				• Murmur of aortic insufficiency
		and
• Known thoracic aortic aneurysm				(new or not known to be old
		• Ripping/ tearing/ sharp or
				and in conjunction with pain)

stabbing quality

• Hypotension or shock state

Determine pre-test risk by combination of risk conditions, history, and exam.

STEP 3

Risk based diagnostic evaluation

STEP 4

Acute AoD identified or excluded

Low Risk	T5	Intermediate Risk T4	High Risk	T3
No high risk features		Any single high risk	Two or more high risk
		feature present.
present.			features present.

Proceed with diagnostic evaluation as clinically

indicated by presentation.

Alternative diagnosis identified?

Yes

No

Initiate appropriate therapy.

T9 Yes

Unexplained hypotension or widened mediastinum on CXR?

No

Consider aortic imaging study for TAD T10 based on clinical scenario (particularly in patients with advanced age, risk factors

for aortic disease, or syncope).

EKG consistent	Yes
with STEMI?

No

CXR with clear T7 Yes alternate diagnosis?

No

History and physical

exam strongly Yes suggestive of specific alternate diagnosis

No

T6

Likely primary ACS. In absence of other perfusion deficits strongly consider immediate coronary re-perfusion therapy. If coronary angiography performed is culprit lesion identified?

Yes

No

Initiate appropriate therapy.

Yes

Alternate diagnosis T8 confirmed by further testing?

No

Expedited aortic imaging

Aortic Imaging Study	T11

•TEE (preferred if clinically unstable)

•CT with contrast (Image entire aorta:

•MR chest to pelvis)

If high clinical suspicion for T12	No
aortic dissection exists, consider	Aortic Dissection Present?
secondary imaging study.

Yes

Immediate surgical consultation and arrange for expedited aortic imaging.

Proceed to Treatment Pathway

Figure 25.  AoD evaluation pathway. ACS indicates acute coronary syndrome; AoD, aortic dissection; BP, blood pressure; CNS, central nervous system; CT, computed tomographic imaging; CXR, chest x-ray; EKG, electrocardiogram; MR, magnetic resonance imaging; STEMI, ST-elevation myocardial infarction; TAD; thoracic aortic disease; and TEE, transesophageal echocardiogram.

Data Supplement to: “2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine”

Technique Parameters and Anatomical Coverage for Thoracic Aortic Computed Tomography Studies

	Scan Parameter	Parameter Specification	Comments
			• The mAs selected should result in diagnostic-quality images56
	mAs		• Should take into account the patient’s body habitus and age,
			collimation, kVp, and unique attributes of the scanner and acquisition
			mode56
	Max.tube rotation	≤1 s57
	time
	kVp	120 to 140 kVp56
	Collimation2	≤3 mm
	Pitch (IEC	Between 1.0 and 1.75
	definition)
			• 60% ionic or 300 mg/mL nonionic contrast
	IV contrast		• Dense enhancement of the thoracic aorta that is sustained throughout
		80 to 150 cc56	the sequence of scans may suggest an excessive contrast dose for the
	medium		patient’s weight
			• Higher or lower volumes may be used if the protocol states that the
			volume may be adjusted for patient weight
	Oral contrast	N/A56	• If used, oral contrast should not produce streaking artifact
	Injection rate	3 to 5 mL/s56
			• The scan should be completed prior to visual evidence or significant
	Scan delay	Computer assisted or	washout of intra-aortic contrast
		empiric standardized56	• This is best assessed in the chest by noting little or no difference
			between intra-aortic density and muscle attenuation
	Reconstruction	Standard or soft tissue56
	algorithm
		Should overlap at least	• In situations where helical scans are reconstructed at overlapping
	Reconstruction	50% of the slice thickness	intervals (eg, every 1.25 mm) for cine viewing on a workstation and
		for helical scans if the	to obtain high-quality reconstructions, it is reasonable for every
	spacing
		capability of the scanner	second or third image to be photographed in an attempt to reduce the
		used is <64 slices56	number of films required to display the entire study
	CTDIvol	There are no reference	• The CTDIvol should be appropriate for the examination
		values for this examination
		Above the aortic arch to at
		least the level of the
	Coverage	aortoiliac bifurcation56
		(may include pelvic
		arteries, particularly to
		evaluate endovascular
		repair access pathway)
	Gantry tilt	N/A

Scan Parameter	Parameter Specification	Comments
	Should not be so small that
	a portion of the aorta is
Display FOV	excluded or so large that
	edge of the image lies well
	beyond the edge of the
	patient’s body56
	Lung and mediastinum56
	Lung:
	• WW = 1200 to	• The settings should allow adequate visualization of the aortic lumen
Display window	1500 HU	and should not display an aorta so dense that it is indistinguishable
width/level	WL = –550 to –700 HU	from cortical bone, or so hypodense that it is virtually
	Mediastinum:	indistinguishable from normal soft-tissue (ie, chest wall musculature)
	• WW = 250 to 450
	HU
	• WL = 40 to 80 HU

From: American College of Radiology. ACR CT Accreditation Clinical Image Quality Guide56; Fan et al.57

cc indicates cubic centimeter; CTDIvol, Computed Tomography Dose Index; FOV, field of view; HU, Hounsfield units; IEC, International Electrotechnical Commission; IV, intravenous; kVp, kilovolt peak; mAs, millimere seconds; N/A, not available; WL, window level; and WW, window width.