Research paperDose reduction techniques in coronary calcium scoring: The effect of iterative reconstruction combined with low tube voltage on calcium scores in a thoracic phantom

•Low tube voltage combined with iterative reconstruction allows for dose reduced protocols.•90 kVp-IR3 and 100 kVp-IR1 yield similar results as the conventional CAC protocol.•CAC HU-threshold does not need to be adjusted for 90 kVp-IR3 or 100 kVp-IR1.

ObjectivesTo define a dose-reduced coronary calcium CT protocol that provides similar calcium score values as a conventional 120 kVp protocol.MethodsA thorax phantom containing 100 calcifications was scanned with the reference protocol (120 kVp, 90 ref mAs, FBP) and 30 dose-reduced protocols (70-110 kVp, 90 ref mAs, FBP and iterative reconstruction (IR) levels 1-5) with 3rd generation dual-source CT. For protocols that yielded similar detectability and calcium scores as the reference protocol, additional scans were acquired at reduced ref mAs. Kendall's τb and independent-samples-median test were used to determine trends and differences in contrast/signal-to-noise ratio (CNR and SNR), dose and calcium scores.ResultsThe detectability and calcium scores decreased at increasing IR levels (τb < − 0.825, p < 0.001) and increasing tube voltage (τb < − 0.679, p < 0.001). For 90 kVp-IR3 and 100 kVp-IR1, similar detectability and calcium score was found compared to the reference protocol (p > 0.206). For these protocols, lower tube currents did not affect the detectability and Agatston score (p > 0.206), while CNR and SNR were similar/higher compared to the reference protocol (0.008 < p < 0.206). Dose reduction was 60.6% (90 kVp-IR3) and 43.6% (100 kVp-IR1).ConclusionsThe protocol of 90 kVp-IR3 and 100 kVp-IR1 yielded similar calcium detectability, Agatston score and image quality as the reference protocol, with dose reduction up to 60.6%.