Enhancing Radiation Dose Efficiency in Prospective ECG-Triggered Coronary CT Angiography Using Calcium-Scoring CT

Background: This study investigates whether the scan length adjustment of prospectively ECG-triggered coronary CT angiography (CCTA) using calcium-scoring CT (CAS-CT) images can reduce overall radiation doses. Methods: A retrospective analysis was conducted on 182 patients who underwent CAS-CT and prospectively ECG-triggered CCTA using a second-generation Dual-Source CT scanner. CCTA planning was based on CAS-CT images, for which simulated scout view planning was performed for comparison. Effective doses were compared between two scenarios: Scenario 1—CAS-CT-derived CCTA + CAS-CT and Scenario 2—scout-view-derived CCTA without CAS-CT. Dose differences were further analyzed with respect to scan mode and body mass index. Results: Planning CCTA using CAS-CT led to a shorter scan length than planning via scout view (114.3 ± 9.7 mm vs. 133.7 ± 13.2 mm, p < 0.001). The whole-examination effective dose was slightly lower for Scenario 1 (3.2 [1.8–5.3] mSv vs. 3.4 [1.5–5.9] mSv; p < 0.001, n = 182). Notably, Scenario 1 resulted in a significantly lower radiation dose for sequential scans and obese patients. Only high-pitch spiral CCTA showed dose reduction in Scenario 2. Conclusions: Using CAS-CT for planning prospectively ECG-triggered CCTA reduced the overall radiation dose administered compared to scout view planning without CAS-CT, except for high-pitch spiral CCTA, where a slightly opposite effect was observed.