we prospectively analysed radiation dose and determinants in four cohorts of consecutive patients (n = 525) undergoing CCT at pre-defined time points -post-installation, post console upgrades and post introduction of an iterative image reconstruction algorithm (AIDR3D). The impact of these updates on radiation dose were analysed by BMI subgroups (BMI ≤ 20,20 < BMI ≤ 25,25 < BMI ≤ 30,30 < BMI ≤ 35,35 < BMI). Summary statistics were compared with means or medians (S.D. or interquartile range) as appropriate. Comparisons of radiation dose between cohorts were by independent samples median test. Baseline characteristics (age, sex, BMI) were similar between all cohorts.Results: Progressive reductions in radiation dose were seen across all BMI subgroups. Comparing the first and fourth cohorts there were significant reductions in median radiation dose across all subgroups (p < 0.02). Individuals with a BMI > 35 had reduced median dose-length product from 1142.3 mGy cm (IQR: 915-1759, n = 31) (1st cohort) to 318.4 mGy cm (IQR: 254-515, n = 16) (4th cohort) (p < 0.001). All CCTs were of diagnostic quality.

In recent years advances in our understanding of coronary disease, risk stratification and technology developments in CT scanning have dramatically changed the way we investigate patients with suspected coronary artery disease. These developments have been refected in recent NICE guidance for the investigation of patients with new onset chest pain. These guidelines advise greater use of CT coronary angiography (CTCA) in low- to intermediate-risk patients and suggest there is no role for exercise tolerance testing in the assessment of patients with chest pain of uncertain origin. This article will describe the technique of CTCA and its use in the investigation of patients with suspected symptomatic coronary artery disease.

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