Single-Bolus Sequential Triple-Rule-Out CT Angiography: Image Quality and Radiation Dose on Wide-Area Detector and Dual-Source CT
In brief
Wide-area detector CT used 38% less estimated radiation in triple-rule-out scans
In this retrospective comparison of 114 adults, wide-area detector CT used 38% less estimated radiation than dual-source CT, with acceptable image quality across pulmonary, coronary and aortic phases. Dual-source CT had less aortic-root motion artifact and higher right coronary artery contrast, but the study did not test diagnostic accuracy, so which approach better detects disease remains unknown.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 15 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Hyun Jung Kim, Jin Woo Kim, Sung-Jin Cha, Sung Min Ko
- PMID
- 42795938
- DOI
- 10.3390/jcm15187166
Why clinicians should know about it
- Picked for Medical Physics (top studies of the week, 27 September 2026).
Abstract
Background/Objectives: Single-pass triple-rule-out computed tomography (CT) angiography (TRO-CTA) must compromise among differing pulmonary, coronary, and aortic contrast-transit times. Wide-area detector CT (WAD-CT) and dual-source CT (DSCT) offer different coverage, temporal resolution, and dose profiles, but direct comparative evidence for a sequential single-bolus strategy is limited in selected emergency patients with overlapping concern for acute coronary syndrome, pulmonary embolism, or acute aortic syndrome. We compared territory-specific image quality and radiation dose; diagnostic accuracy was not assessed. Methods: This retrospective study included 114 adults (WAD-CT, n = 60; DSCT, n = 54). After test-bolus timing, one weight-based diagnostic bolus was used for sequential pulmonary, electrocardiography-synchronized coronary, and non-gated aortic acquisitions. Attenuation, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), blinded dual-reader quality scores, and radiation dose were compared by territory. Results: Mean overall scores across the two readers were ≥3 for every examination in all phases. WAD-CT showed higher pulmonary trunk SNR (19.5 ± 8.9 vs. 14.3 ± 3.8; p = 0.002), higher ascending aortic SNR (24.9 ± 11.4 vs. 14.2 ± 3.0; p < 0.001), lower coronary and aortic noise, and 38.1% lower total estimated dose (6.40 ± 1.72 vs. 10.34 ± 6.91 mSv; p < 0.001). DSCT showed higher right coronary attenuation (671.8 ± 186.7 vs. 466.4 ± 128.9 Hounsfield units; p < 0.001), no significant difference in right coronary SNR (p = 0.681), and less aortic-root pulsation artifact (p < 0.001). Pulmonary- and coronary-phase overall scores were comparable. Conclusions: Both protocols provided acceptable territory-level image quality from one diagnostic bolus. WAD-CT provided lower coronary and aortic noise and estimated radiation dose, whereas DSCT provided higher coronary attenuation and less aortic-root pulsation artifact. Diagnostic accuracy and performance in subsegmental pulmonary arteries and distal or small coronary branches remain unestablished.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.