The sub-millisievert era in CTCA: the technical basis of the new radiation dose approach.
Level 5 - mechanism / opinion, no new human data
Narrative review describing technical principles and protocol optimizations without a systematic review methodology or primary empirical dataset.
PubMed 32930945 · doi:10.1007/s11547-020-01280-1
What was done
This narrative review outlines the technical strategies required to achieve sub-millisievert (<1 mSv) radiation doses in computed tomography coronary angiography (CTCA). The abstract details key protocol components, including the implementation of low tube voltage, prospective electrocardiogram (ECG)-triggering spiral protocols, tube current modulation, and iterative reconstruction algorithms.
What was found
The abstract reports no primary quantitative data or pooled statistical metrics. It describes how optimizing CTCA acquisition parameters allows substantial radiation dose reductions despite persistent wide variations in clinical practice across institutions. The review notes that routine sub-mSv baseline anatomical imaging lowers cumulative exposure, facilitating the complementary use of functional assessment modalities such as CT myocardial perfusion, fractional flow reserve CT (FFR-CT), dual-energy CT, and artificial intelligence tools.
Why it matters
Standardizing technical protocols to achieve sub-mSv CTCA improves the risk-benefit balance of cardiac imaging and enables comprehensive combined morphological and hemodynamic assessment of coronary artery disease.
Limits
The abstract contains no empirical data, sample size, or systematic methodology. Practical limitations, such as the impact of high body mass index, elevated heart rates, severe coronary calcification, or equipment vendor variability on image quality at low radiation doses, are not reported in the abstract.
Cited by
- supports Coronary CT angiograms exposed patients to around 20 millisieverts of radiation 20 years ago, whereas modern CTAs deliver less than 1 millisievert.