Radiation dose from coronary CT angiography: five years of progress

Radiation doses from coronary CT angiography have been scrutinized as a consequence of rising concern over cumulative lifetime radiation dose from diagnostic imaging and potential cancer risk. In response to this, the past 5 years have witnessed progressive refinements in CT technology and new dose reduction protocols, including electrocardiography-based tube current modulation, lower peak tube voltage, prospective or axial scanning, high-pitch spiral scanning, and iterative CT data reconstruction. As a direct result, compared with radiation exposure levels initially reported from 64-detector coronary CT angiography without dose modulation (range, 16-20 mSv), doses have decreased by approximately 50% every 2 years since 2005. Recent high-pitch spiral scan studies have documented doses ≤ 1 mSv. In routine clinical practice, registries show somewhat higher radiation dose levels, but nonetheless a similar rate of improvement with marked dose reduction enabled by dissemination of updated CT scanner technology. The current challenge is to continue the past rate of progress by incorporating research into practice and to facilitate improved technology.