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. 2025 Jun 1;15(3):281-290.
doi: 10.31661/jbpe.v0i0.2209-1537. eCollection 2025 Jun.

Optimization of Retrospective Gated-ECG Coronary Computed Tomography Angiography by Dose Reduction in Patients with Different Body Mass Indexes

Behzad Fazlkhah  1 , Mona Fazel Ghaziyani  1 , Leyla Dinparast  2 , Vahid Alinejad  3 , Yunus Soleymani  4 , Davood Khezerloo  1
Affiliations

Optimization of Retrospective Gated-ECG Coronary Computed Tomography Angiography by Dose Reduction in Patients with Different Body Mass Indexes

Behzad Fazlkhah et al. J Biomed Phys Eng. .

Abstract

Background: The reduction of patient radiation dose in coronary Computed Tomography Angiography (CCTA) with acceptable image quality is considered an important factor in the research.

Objective: This study aims to optimize the CCTA protocol using a retrospective Electrocardiogram (ECG)-gated axial scan protocol in patients with different Body Mass Indexes (BMIs).

Material and methods: In this cross-sectional study, 66 patients into three main groups: 80 kVp (Group A), 100 kVp (Group B), and 120 kVp (Group C), underwent CCTA. Each group was then divided into two subgroups of BMI<25 and >25 kg/m2. Image noise, mean vascular attenuation at the aorta, signal-to-noise ratio (SNR), and Contrast-to-Noise Ratio (CNR) at five regions of coronary arteries, in which Coronary artery anomalies are common were qualitatively evaluated by subjective image quality analysis.

Results: At each kVp, there were no significant differences in CNR, SNR, noise level, and the effective dose between BMI>25 kg/m2 and BMI<25 kg/m2. The effective radiation dose of groups A, B, and C were 4.16, 8.46, and 14.3 mSv, respectively. Subjective image quality assessment scores were 3.18, 3.5, and 3.73 out of 4 in groups A, B, and C, respectively.

Conclusion: Patient radiation dose using retrospective ECG-gated CCTA can be reduced by about 70% at 80 kVp, which is almost close to the prospective CCTA dose ranges. The retrospective CCTA at 80 kVp can be optimized even in overweight patients (BMI>25 kg/m2).

Keywords: Computed Tomography Angiography; Effective Radiation Dose; Electrocardiography; Low Dose CT Angiography; Radiation Dosage; Retrospective Computed Tomography Angiography; Tube Voltage Reduction.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Retrospective ECG-gated CCTA images of subjects for RCA and LCA with different BMI and tube voltages. (A1) 80 KVp and 24.59 kg/m2, (A2) 80 KVp and 27.79 kg/m2, (B1) 100 KVp and 23.89 kg/m2, (B2) 100 KVp and 27.42 kg/m2, (C1) 120 KVp and 25 kg/m2, (C2) 120 KVp and 28.2 kg/m2. (ECG: Electrocardiogram, CCTA: Coronary Computed Tomography Angiography, RCA: Right Coronary Artery, LCA: Left Coronary Artery, BMI: Body Mass Index)
Figure 2
Figure 2
Effective Dose at different tube voltages in the study groups
Figure 3
Figure 3
Noise levels at different tube voltages in the study groups
Figure 4
Figure 4
Subjective quality scores of Coronary Computed Tomography Angiography (CCTA) images at different tube voltages in the study groups
See this image and copyright information in PMC

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