ArticleInsights into imaging2026
High-pitch free-breathing triple rule-out CT angiography for acute chest pain: a prospective sequential two-cohort comparison of radiation dose and diagnostic image quality.
Article in Insights into imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo 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
methodsThis 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.
resultsRadiation 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 < 0.001). Vascular attenuation was significantly higher in Group A in the coronary arteries, main pulmonary artery, and ascending aorta (p < 0.05), whereas CNR was higher in Group B (all p < 0.01). Subjective image quality scores, including coronary diagnostic segment rates (98.0% vs 97.5%), were comparable across all vascular territories (all p > 0.05). Clinical diagnoses were similarly distributed between groups (p = 0.455).
conclusionHigh-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.
findingsThe 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.
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