Radiation Dose Optimization in Coronary CT Angiography: A Quality Improvement Initiative.

BACKGROUND: Coronary computed tomography angiography (CCTA) is increasingly used for the evaluation of coronary artery disease; however, radiation exposure remains a patient safety concern. Data on radiation dose optimization from low- and middle-income countries are limited. PROJECT RATIONALE: Tabba Heart Institute Karachi identified opportunities to reduce CCTA radiation exposure through implementation of heart rate and body mass index-guided acquisition protocols while maintaining image quality. PROJECT SUMMARY: A quality improvement initiative was implemented using patient-specific scanning protocols. A total of 422 CCTA examinations were evaluated, including 117 preintervention and 305 postintervention studies. Median effective radiation dose decreased by 45.5%, from 8.8 mSv to 4.8 mSv (P < 0.001). CCTA dose-length product decreased by 46.5% and total dose-length product by 39.8% (both P < 0.001). No significant differences were observed in image quality metrics or repeat scan rates. TAKE-HOME MESSAGE: Technologist-driven protocol optimization can substantially reduce CCTA radiation exposure without compromising image quality and may serve as a scalable model for cardiovascular imaging programs in resource-constrained settings.