Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Meinel FG, Schoepf UJ, Townsend JC, Flowers BA, Geyer LL, Ebersberger U, et al. Diagnostic yield and accuracy of coronary CT angiography after abnormal nuclear myocardial perfusion imaging. Sci Rep. 2018;8(1):9228. doi: 10.1038/s41598-018-27347-8. [ PMC Free Article ] - DOI - PMC - PubMed
    1. Maurya VK, Ravikumar R, Sharma P, Agrawal N, Bhatia M. Coronary CT angiography: A retrospective study of 220 cases. Med J Armed Forces India. 2016;72(4):377–83. doi: 10.1016/j.mjafi.2016.03.008. [ PMC Free Article ] - DOI - PMC - PubMed
    1. Gupta S, Meyersohn NM, Wood MJ, Steigner ML, Blankstein R, Ghoshhajra BB, Hedgire SS. Role of Coronary CT Angiography in Spontaneous Coronary Artery Dissection. Radiol Cardiothorac Imaging. 2020;2(6):e200364. doi: 10.1148/ryct.2020200364. [ PMC Free Article ] - DOI - PMC - PubMed
    1. Deseive S, Chen MY, Korosoglou G, Leipsic J, Martuscelli E, Carrascosa P, et al. Prospective Randomized Trial on Radiation Dose Estimates of CT Angiography Applying Iterative Image Reconstruction: The PROTECTION V Study. JACC Cardiovasc Imaging. 2015;8(8):888–96. doi: 10.1016/j.jcmg.2015.02.024. - DOI - PubMed
    1. Sabarudin A, Siong TW, Chin AW, Hoong NK, Karim MKA. A comparison study of radiation effective dose in ECG-Gated Coronary CT Angiography and calcium scoring examinations performed with a dual-source CT scanner. Sci Rep. 2019;9(1):4374. doi: 10.1038/s41598-019-40758-5. [ PMC Free Article ] - DOI - PMC - PubMed

LinkOut - more resources