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However, the combined impact of patient size, tube voltage, and heart rate (HR) on VMI of coronary CT angiography (CCTA) remains unknown. This phantom study aimed to assess VMI levels achieving comparable contrast-to-noise ratio (CNR) in CCTA at 50% CM dose across varying tube voltages, patient sizes, and HR, compared to the reference protocol (100% CM dose, conventional at 120 kVp). A 5\u00a0mm artificial coronary artery with 100% (400 HU) and 50% (200 HU) iodine CM-dose was positioned centrally in an anthropomorphic thorax phantom. Horizontal coronary movement was matched to HR (at 0, &lt;\u200960, 60\u201375, &gt;\u200975\u00a0bpm), with varying patient sizes simulated using phantom extension rings. Raw data was acquired using a clinical CCTA protocol at 120 and 140 kVp (five repetitions). VMI images (40\u201370\u00a0keV, 5\u00a0keV steps) were then reconstructed; non-overlapping 95% CNR confidence intervals indicated significant differences from the reference. Higher CM-dose, reduced VMI, slower HR, higher tube voltage, and smaller patient sizes demonstrated a trend of higher CNR. Regardless of HR, patient size, and tube voltage, no significant CNR differences were found compared to the reference, with 100% CM dose at 60\u00a0keV, or 50% CM dose at 40\u00a0keV. DLCT reconstructions at 40\u00a0keV from 120 to 140 kVp acquisitions facilitate 50% CM dose reduction for various patient sizes and HR with equivalent CNR to conventional CCTA at 100% CM dose, although clinical validation is needed.<\/jats:p>","DOI":"10.1007\/s10554-024-03062-6","type":"journal-article","created":{"date-parts":[[2024,2,22]],"date-time":"2024-02-22T05:02:35Z","timestamp":1708578155000},"page":"931-940","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Halved contrast medium dose coronary dual-layer CT-angiography \u2013 phantom study of tube current and patient characteristics"],"prefix":"10.1007","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8591-8029","authenticated-orcid":false,"given":"C. 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All speaker fees associated with their presentations have been directed to their respective affiliated healthcare institutions rather than being received personally. Niels van der Werf and Cathrine Kristiansen are full-time and part-time employees of Philips Healthcare, respectively. The other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}