Assessment of coronary artery calcium using dual-energy subtraction digital radiography

John N. Mafi, Baowei Fei, Sharon Roble, Anthony Dota, Prashanth Katrapati, Hiram G. Bezerra, Hesheng Wang, Wei Wang, Leslie Ciancibello, Marco Costa, Daniel I. Simon, Carl E. Orringer, Robert C. Gilkeson

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Cardiovascular disease is the leading cause of global mortality, yet its early detection remains a vexing problem of modern medicine. Although the computed tomography (CT) calcium score predicts cardiovascular risk, relatively high cost ($250-400) and radiation dose (1-3 mSv) limit its universal utility as a screening tool. Dualenergy digital subtraction radiography (DE; <$60, 0.07 mSv) enables detection of calcified structures with high sensitivity. In this pilot study, we examined DE radiography's ability to quantify coronary artery calcification (CAC). We identified 25 patients who underwent noncontrast CT and DE chest imaging performed within 12 months using documented CAC as the major inclusion criteria. A DE calcium score was developed based on pixel intensity multiplied by the area of the calcified plaque. DE scores were plotted against CT scores. Subsequently, a validation cohort of 14 additional patients was independently evaluated to confirm the accuracy and precision of CAC quantification, yielding a total of 39 subjects. Among all subjects (n=39), the DE score demonstrated a correlation coefficient of 0.87 (p<0.0001) when compared with the CT score. For the 13 patients with CT scores of <400, the correlation coefficient was -0.26. For the 26 patients with CT scores of ≥400, the correlation coefficient yielded 0.86. This pilot study demonstrates the feasibility of DE radiography to identify patients at the highest cardiovascular risk. DE radiography's accuracy at lower scores remains unclear. Further evaluation of DE radiography as an inexpensive and low-radiation imaging tool to diagnose cardiovascular disease appears warranted.

Original languageEnglish (US)
Pages (from-to)129-136
Number of pages8
JournalJournal of Digital Imaging
Issue number1
StatePublished - Feb 2012
Externally publishedYes


  • Calcification detection
  • Cardiac imaging
  • Chest CT
  • Chest radiographs
  • Computed tomography
  • Coronary arteries
  • Coronary calcifications
  • Coronary disease
  • Digital radiography
  • Digital subtraction radiography
  • Dual-energy scanned projection
  • Dual-energy subtraction
  • ROC-based analysis
  • Radiography

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology
  • Radiology Nuclear Medicine and imaging
  • Computer Science Applications


Dive into the research topics of 'Assessment of coronary artery calcium using dual-energy subtraction digital radiography'. Together they form a unique fingerprint.

Cite this