Low-kVp techniques for radiation dose optimization in abdominopelvic contrast-enhanced CT: a scoping review

Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis is widely used for diagnostic imaging but contributes substantially to cumulative medical radiation exposure. Low tube voltage (kVp) imaging has gained attention as a practical strategy for radiation dose optimization while maintaining diagnostic image quality.The study aimed to map the current evidence on low-kVp techniques for radiation dose reduction in adult abdominopelvic CECT and evaluate their effects on radiation dose and image quality. This scoping review was conducted in accordance with the Arksey and O'Malley framework and PRISMA-ScR guidelines. A systematic search of Scopus, PubMed, Web of Science, Cochrane Library, and CINAHL identified studies published between 2000 and 2025 that reported low-kVp dose optimization strategies in adult patients. Data were extracted on scanner characteristics, tube voltage settings, reconstruction techniques, and reported dose reductions. Thirteen studies (sample size: 30-907) patients were included. Tube voltage settings ranged from 80 to 120 kVp, with 80 kVp consistently achieving substantial dose reductions (11-86%), particularly when combined with hybrid, model-based, or deep learning reconstruction algorithms that mitigated image noise and preserved diagnostic confidence. Automatic tube voltage selection and patient size-adapted protocols further supported individualized dose optimization. However, considerable heterogeneity in imaging protocols, reconstruction methods, and dose metrics limited comparability across studies. Low-kVp imaging is an effective approach for reducing radiation dose in contrast-enhanced abdominopelvic CT without compromising diagnostic adequacy. Standardized reporting and large prospective multicenter studies are needed to establish optimal protocols and support broader clinical implementation.