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Low-Dose Radiation Advances in Coronary Computed Tomography Angiography in the Diagnosis of Coronary Artery Disease

[ Vol. 15 , Issue. 4 ]


Caryl E. Richards and Daniel R. Obaid*   Pages 304 - 315 ( 12 )


Background: Coronary computed tomography angiography (CCTA) is now widely used in the diagnosis of coronary artery disease since it is a rapid, minimally invasive test with a diagnostic accuracy comparable to coronary angiography. However, to meet demands for increasing spatial and temporal resolution, higher x-ray radiation doses are required to circumvent the resulting increase in image noise. Exposure to high doses of ionizing radiation with CT imaging is a major health concern due to the potential risk of radiation-associated malignancy. Given its increasing use, a number of dose saving algorithms have been implemented to CCTA to minimize radiation exposure to “as low as reasonably achievable (ALARA)” without compromising diagnostic image quality.

Objective: The purpose of this review is to outline the most recent advances and current status of dose saving techniques in CCTA.

Method: PubMed, Medline, EMBASE and Scholar databases were searched to identify feasibility studies, clinical trials, and technology guidelines on the technical advances in CT scanner hardware and reconstruction software.

Results: Sub-millisievert (mSv) radiation doses have been reported for CCTA due to a combination of strategies such as prospective electrocardiogram-gating, high-pitch helical acquisition, tube current modulation, tube voltage reduction, heart rate reduction, and the most recent novel adaptive iterative reconstruction algorithms.

Conclusion: Advances in radiation dose reduction without loss of image quality justify the use of CCTA as a non-invasive alternative to coronary catheterization in the diagnosis of coronary artery disease.


Coronary computed tomography angiography, effective radiation dose, image quality, prospective electrocardiogram- gating, tube voltage reduction, tube current modulation, iterative reconstruction.


Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, Department of Cardiology, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL

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