radiation dose reduction Archives

With patient safety top of mind these days, radiology professionals are correct to focus on performing CT scans with less radiation. To that end, three recently published research studies highlight new protocols to do just that.

Radiation safety has been one of the top radiology stories in 2025 following several studies underscoring the links between medical radiation and cancer.

The irony is that patient radiation exposure can be reduced dramatically using protocols that already exist – it’s just a matter of applying them consistently in the real world.

In the first paper, published in European Journal of Radiology, researchers share their MINDS-CAD protocol for coronary CT angiography.

MINDS-CAD relies on tailoring contrast dose to patient weight and CT scanner tube voltage using a five-step process.

MINDS-CAD was tested with 112 obese patients getting clinically indicated CCTA with Siemens Healthineers’ Somatom Force dual-source CT scanner and Bayer’s Ultravist 370 contrast agent. Researchers found that compared to a conventional tube voltage-adapted protocol, MINDS-CAD…

Achieved superior image quality according to cases rated “good” or “excellent” (86% vs. 75%).
Generated fewer poor-quality scans (3.5% vs. 8.8%).
Produced sharply lower radiation dose (99 vs. 386 mGy•cm).
Saw no link between vascular attenuation and BMI or tube voltage.

In a second EJR paper, researchers from India tested the ability of an AI-based reconstruction algorithm to reduce dose in cerebral CTA exams.

They used Philips’ Precise Image AI-based reconstruction protocol, which produces images resembling traditional filtered back projection scans while reducing noise like advanced iterative reconstruction methods.

In tests with 68 patients who got cerebral CTA at 100 kVp, compared to iterative reconstruction, Precise Image…

Improved contrast-to-noise ratio 26%, signal-to-noise ratio 22%, and visual noise 16%.
Generated higher image quality scores from radiologists.
Generated an extremely low median effective dose of 0.785 mSv.

Finally, a third study – this one in Clinical Radiology – used a “double low” technique of low-energy 50 keV images on GE HealthCare’s Revolution Apex dual-energy CT scanner with TrueFidelity deep learning image reconstruction on 60 patients with cirrhotic liver disease.

Compared with a conventional protocol, the double-low technique had 48% lower radiation entrance dose (4.10 vs. 7.88 mSv) and 32% lower contrast dose (67.3 vs. 99.1 mL), while image quality was rated higher.

The Takeaway

Taken together, the new papers show that radiology’s radiation dose challenge is eminently solvable thanks to the ingenuity of clinicians and researchers who are pioneering new ways to scan.

CT radiation dose has been one of the top radiology headlines this year due to the publication of several studies linking radiation to cancer risk. But new research offers hope that CT radiation dose can be reduced, even across large healthcare systems.

CT’s link to cancer risk has been controversial, but most established models connect low-level radiation to cancer formation.

The debate heated up this year with a September study linking radiation to pediatric blood cancers, following research in April claiming CT radiation would account for 5% of all cancers in the U.S. in a year at current dose levels.

There are lots of great technologies for reducing CT radiation dose, from photon-counting CT to adjusting scanner parameters like mA and kVp, while image reconstruction algorithms can upscale noisy low-dose images to look like higher-quality exams.

But the problem has always been getting these technologies into the hands of clinicians – and then making sure they use them, especially across large multi-center health systems, where dose can vary even within the same network.

Taking a crack at the problem were cardiologists from Lee Health Heart Institute in Fort Myers, Florida, in a new paper in JACC: Case Reports.

They specifically looked at radiation dose for coronary CT angiography exams, determining that based on the literature an optimal radiation dose for CCTA should be ≤ 4 mSv – lower than the system’s 6.2 mSv median dose.

So they implemented several strategies for reducing CCTA dose…

Standardizing scanning protocols that emphasized prospective ECG gating, reduced field of view, BMI-tailored tube voltage (kVp), and elimination of redundant imaging phases.
Setting parameters for single-source CT at 100 kVp for patients with BMI <30 and 120 kVp for BMI ≥30, with prospective scanning for 60-80% of the cardiac cycle.
Using similar kVp settings for dual-source CT scanners, but implementing systolic imaging between 250-450 milliseconds.

How well did it work? After reviewing the program, researchers found…

System-wide radiation dose fell 23% (4.8 vs. 6.2 mSv).
Diagnostic quality improved as measured by the acceptance rate for FFR-CT exams (93% vs. 91%).
Dose consistency was achieved across locations despite differences in scanner models and practices.

The Takeaway

The new study on CCTA radiation dose shows that dose can be reduced system-wide while maintaining – and even improving – diagnostic image quality. Is it a problem that the research was led by cardiologists and not radiologists? Not if you’re a patient.

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