Abstract
Abstract
Objectives
To evaluate the feasibility of high-pitch free-breathing triple rule-out CT angiography (TRO-CTA) by comparing image quality and radiation dose with a standard breath-hold protocol in patients with acute chest pain.
Materials and methods
This prospective study enrolled 104 patients with acute chest pain who underwent TRO-CTA on a third-generation dual-source CT scanner, sequentially allocated to high-pitch free-breathing TRO-CTA (pitch = 3.2; Group A,
n
= 52) or standard breath-hold TRO-CTA (standard pitch; Group B,
n
= 52). Objective image quality (attenuation, noise, signal-to-noise ratio [SNR], and contrast-to-noise ratio [CNR]) was assessed across the coronary, pulmonary, and aortic territories. Subjective image quality (3-point scale), effective dose (ED), acquisition time, and clinical diagnoses were compared between groups.
Results
Radiation dose (ED: 1.81 ± 1.33 vs 15.63 ± 6.71 mSv) and acquisition time (0.48 ± 0.05 vs 6.83 ± 1.87 s) were significantly lower in Group A than in Group B (all
p
p
p
p
> 0.05). Clinical diagnoses were similarly distributed between groups (
p
= 0.455).
Conclusion
High-pitch free-breathing TRO-CTA substantially reduces radiation dose while preserving comparable diagnostic image quality, offering a clinically feasible low-dose alternative to standard breath-hold protocols for emergency patients with acute chest pain, particularly those with well-controlled heart rates.
Key Points
Question
: Conventional TRO-CTA involves high radiation exposure (8.93–17.5 mSv) and breath-holding, posing safety and feasibility challenges in emergency patients with acute chest pain.
Findings
: The high-pitch free-breathing protocol reduced effective dose by 88% and acquisition time from 6.83 to 0.48 s while providing comparable diagnostic image quality.
Critical relevance statement
: High-pitch free-breathing TRO-CTA may offer a low-dose imaging option on dual-source CT, with the potential to support more time-efficient emergency evaluation of acute chest pain.