Trading off Iodine and Radiation Dose in Coronary Computed Tomography.

Journal: Journal of cardiovascular development and disease
Published Date: May 20, 2025

Abstract

Coronary CT angiography (CCTA) has seen steady progress since its inception, becoming a key player in the non-invasive assessment of coronary artery disease (CAD). Advancements in CT technology, including iterative and deep-learning-based reconstruction, wide-area detectors, and dual-source systems, have helped mitigate early limitations, such as high radiation doses, motion artifacts, high iodine load, and non-diagnostic image quality. However, the adjustments between ionizing radiation and iodinated contrast material (CM) volumes remain a critical concern, especially due to the increasing use of CCTA in various indications. This review explores the balance between radiation and CM volumes, emphasizing patient-specific protocol optimization to improve diagnostic accuracy while minimizing risks. Radiation dose reduction strategies, such as low tube voltage protocols, prospective ECG-gating, and modern reconstruction algorithms, have significantly decreased radiation exposure, with some studies achieving sub-millisievert doses. Similarly, CM volume optimization, including adjustments in strategies for calculating CM volume, iodine concentration, and flow protocols, plays a role in managing risks such as contrast-associated acute kidney injury, particularly in patients with renal impairment. Emerging technologies, such as photon-counting CT and deep-learning reconstruction, promise further improvements in dose efficiency and image quality. This review summarizes current evidence, highlights the benefits and limitations of dose control approaches, and provides practical recommendations for practitioners. By tailoring protocols to patient characteristics, such as age, renal function, and body habitus, clinicians can achieve an optimal trade-off between diagnostic accuracy and patient safety, ensuring optimal operation of CT systems in clinical practice.

Authors

  • Guillaume Fahrni
    Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
  • Thomas Saliba
    Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
  • Damien Racine
    Institute of Radiation Physics (IRA), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Grand-Pré 1, 1007 Lausanne, Switzerland.
  • Marianna Gulizia
    Department of Radiology and Interventional Radiology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Electronic address: marianna.gulizia@chuv.ch.
  • Georgios Tzimas
    Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
  • Chiara Pozzessere
    Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
  • David C Rotzinger
    Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Electronic address: david.rotzinger@chuv.ch.

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