{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T16:48:47Z","timestamp":1783615727438,"version":"3.55.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T00:00:00Z","timestamp":1769385600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Radiol."],"abstract":"\n Background<\/jats:title>\n Computed tomography angiography (CTA), utilizing iodinated contrast agents, is a first-line diagnostic tool for cardiovascular diseases (CVD). However, the administration of contrast agents introduces potential risks to patients.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study aims to design a novel protocol for CTA that integrates a saline chaser strategy and low-threshold triggering and evaluate, and demonstrate its feasibility and practicality minimizing the required contrast agent for imaging.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A novel protocol for CTA incorporating a saline chaser strategy and low-threshold triggering was developed. Random assignment of eighty patients undergoing CTA examinations divided them into conventional and novel protocol groups. The assessment encompassed iodine intake, radiation dose, image quality, and superior vena cava artefacts in both cohorts.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The novel protocol group exhibited a noteworthy 20% reduction in iodine intake compared to the conventional group (\n P<\/jats:italic>\n \u2009&lt;\u20090.05, FDR correction). Notably, Hounsfield units (HU) of the ascending and descending aorta at the T12 level tended to be lower in the novel protocol group (\n P<\/jats:italic>\n \u2009&lt;\u20090.05, uncorrected), while parameters like signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) exhibited no significant between-group differences. Compared with conventional group, fewer superior vena cava artefacts were observed in the novel protocol group, and subjective image quality assessment by physicians remained consistent between the two groups (kappa\u2009=\u20090.84,\n P<\/jats:italic>\n \u2009&lt;\u20090.01).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The combination of saline chaser strategy with low-threshold triggering in CTA imaging proves a viable approach, significantly curtailing the utilization of iodinated contrast agents, and superior vena cava artefacts.<\/jats:p>\n <\/jats:sec>","DOI":"10.3389\/fradi.2025.1709609","type":"journal-article","created":{"date-parts":[[2026,1,26]],"date-time":"2026-01-26T07:10:26Z","timestamp":1769411426000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Minimizing contrast agent dosage in CT angiography using a saline chaser with a low trigger threshold"],"prefix":"10.3389","volume":"5","author":[{"given":"Linghan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Radiology, Changsha Hospital of Traditional Chinese Medicine (Changsha Eighth Hospital)","place":["Changsha, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojian","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Chaling People\u2019s Hospital","place":["Zhuzhou, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xunhua","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Radiology, Xiangya Hospital, Central South University","place":["Changsha, Hunan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes the task force for the diagnosis and management of chronic coronary syndromes of the European Society of Cardiology (ESC)","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur Heart J"},{"key":"B2","doi-asserted-by":"publisher","first-page":"E153","DOI":"10.1161\/CIR.0000000000001052","article-title":"Heart disease and stroke statistics-2022 update: a report from the American Heart Association","volume":"145","author":"Tsao","year":"2022","journal-title":"Circulation"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s12410-017-9412-6","article-title":"The updated NICE guidelines: cardiac CT as the first-line test for coronary artery disease","volume":"10","author":"Moss","year":"2017","journal-title":"Curr Cardiovasc Imaging Rep"},{"key":"B4","doi-asserted-by":"publisher","first-page":"210102","DOI":"10.1148\/radiol.2021210102","article-title":"Optimized bolus threshold for dual-energy CT angiography with monoenergetic images: a randomized clinical trial","volume":"300","author":"Noda","year":"2021","journal-title":"Radiology"},{"key":"B5","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1097\/RCT.0000000000001337","article-title":"Incidence of contrast-associated acute kidney injury in renal-competent COVID-19 patients undergoing computed chest angiography","volume":"46","author":"Sedaghat","year":"2022","journal-title":"J Comput Assist Tomo"},{"key":"B6","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1007\/s00134-011-2389-8","article-title":"Epidemiology of contrast-associated acute kidney injury in ICU patients: a retrospective cohort analysis","volume":"37","author":"Hoste","year":"2011","journal-title":"Intensive Care Med"},{"key":"B7","doi-asserted-by":"publisher","first-page":"741018","DOI":"10.1155\/2014\/872574","article-title":"Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention","volume":"2014","author":"Andreucci","year":"2014","journal-title":"Biomed Res Int"},{"key":"B8","doi-asserted-by":"publisher","first-page":"e90233","DOI":"10.1371\/journal.pone.0090233","article-title":"The association between contrast dose and renal complications post PCI across the continuum of procedural estimated risk","volume":"9","author":"Kooiman","year":"2014","journal-title":"PLoS One"},{"key":"B9","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1186\/s40658-023-00553-8","article-title":"A systematic review and meta-analysis on the radiation dose of computed tomography in hybrid nuclear medicine imaging","volume":"10","author":"Verfaillie","year":"2023","journal-title":"EJNMMI Phys"},{"key":"B10","doi-asserted-by":"publisher","first-page":"552","DOI":"10.21037\/qims.2019.03.13","article-title":"Personalized administration of contrast medium with high delivery rate in low tube voltage coronary computed tomography angiography","volume":"9","author":"Tan","year":"2019","journal-title":"Quant Imag Med Surg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1148\/radiol.2453061953","article-title":"Saline flush effect for enhancement of aorta and coronary arteries at multidetector CT coronary angiography","volume":"246","author":"Kim","year":"2008","journal-title":"Radiology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"962","DOI":"10.1097\/RCT.0000000000000292","article-title":"Delivering the saline chaser via a spiral flow-generating tube improves arterial enhancement for computed tomography angiography of the lower extremities","volume":"39","author":"Masuda","year":"2015","journal-title":"J Comput Assist Tomogr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1097\/RLI.0b013e3182300603","article-title":"Contrast-enhanced magnetic resonance angiography: first-pass arterial enhancement as a function of gadolinium-chelate concentration, and the saline chaser volume and injection rate","volume":"47","author":"Husarik","year":"2012","journal-title":"Invest Radiol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1938","DOI":"10.1007\/s00330-011-2139-x","article-title":"64-Section multidetector CT of the upper abdomen: optimization of a saline chaser injection protocol for improved vascular and parenchymal contrast enhancement","volume":"21","author":"Marin","year":"2011","journal-title":"Eur Radiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"805","DOI":"10.1016\/j.crad.2019.06.010","article-title":"Effect of a saline flush technique for head and neck imaging in dual-energy CT: improvement of image quality and perivenous artefact reduction using virtual monochromatic imaging","volume":"74","author":"Washio","year":"2019","journal-title":"Clin Radiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"6033","DOI":"10.1007\/s00330-023-09575-3","article-title":"Halved contrast medium dose in lower limb dual-energy computed tomography angiography-a randomized controlled trial","volume":"33","author":"Kristiansen","year":"2023","journal-title":"Eur Radiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"S14","DOI":"10.21037\/cdt.2019.07.04","article-title":"Vascular computed tomography angiography technique and indications","volume":"9","author":"Baliyan","year":"2019","journal-title":"Cardiovasc Diagn Ther"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s40265-022-01803-2","article-title":"Should we interfere with the interleukin-6 receptor during COVID-19: what do we know so far?","volume":"83","author":"Plocque","year":"2023","journal-title":"Drugs"},{"key":"B19","doi-asserted-by":"publisher","first-page":"978763","DOI":"10.3389\/fpsyt.2022.978763","article-title":"Exploring changes in depression and radiology-related publications research focus: a bibliometrics and content analysis based on natural language processing","volume":"13","author":"Wang","year":"2022","journal-title":"Front Psychiatry"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e220101","DOI":"10.1148\/ryct.220101","article-title":"What the baby formula and medical contrast material shortages have in common: insights and recommendations for managing the iodinated contrast media shortage","volume":"4","author":"Ananthakrishnan","year":"2022","journal-title":"Radiol Cardiothorac Imaging"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1016\/j.jacc.2020.01.023","article-title":"Contrast-associated acute kidney injury and serious adverse outcomes following angiography","volume":"75","author":"Weisbord","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"660","DOI":"10.1148\/radiol.2019192094","article-title":"Use of intravenous iodinated contrast media in patients with kidney disease: consensus statements from the American College of Radiology and the National Kidney Foundation","volume":"294","author":"Davenport","year":"2020","journal-title":"Radiology"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.4103\/1319-2442.225199","article-title":"Contrast-induced nephropathy: pathophysiology, risk factors, and prevention","volume":"29","author":"Hossain","year":"2018","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"B24","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1177\/15385744211051503","article-title":"Contrast-associated acute kidney injury in patients with and without diabetes mellitus undergoing computed tomography angiography and local thrombolysis for acute lower limb ischemia","volume":"56","author":"Butt","year":"2022","journal-title":"Vasc Endovasc Surg"},{"key":"B25","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.cjca.2015.05.013","article-title":"Contrast-induced nephropathy: from pathophysiology to preventive strategies","volume":"32","author":"Azzalini","year":"2016","journal-title":"Can J Cardiol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"e2279","DOI":"10.1097\/MD.0000000000002279","article-title":"Iodinated contrast medium exposure during computed tomography increase the risk of subsequent development of thyroid disorders in patients without known thyroid disease a nationwide population-based, propensity score-matched, longitudinal follow-up study","volume":"94","author":"Hsieh","year":"2015","journal-title":"Medicine"},{"key":"B27","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1089\/thy.2022.0393","article-title":"Iodinated contrast administration and risks of thyroid dysfunction: a retrospective cohort analysis of the U.S. veterans health administration system","volume":"33","author":"Inoue","year":"2023","journal-title":"Thyroid"},{"key":"B28","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1136\/heartjnl-2019-314897","article-title":"Imaging for acute aortic syndromes","volume":"106","author":"Carroll","year":"2020","journal-title":"Heart"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1036982","DOI":"10.3389\/fcvm.2022.1036982","article-title":"Progress of CT aortic angiography combined with coronary artery in the evaluation of acute aortic syndrome","volume":"9","author":"An","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1007\/s11547-007-0159-z","article-title":"Diagnostic accuracy of 64-slice CT in the assessment of coronary stents","volume":"112","author":"Cademartiri","year":"2007","journal-title":"Radiol Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1148\/radiol.2372040653","article-title":"Sixteen-detector row CT angiography of carotid arteries: comparison of different volumes of contrast material with and without a bolus chaser","volume":"237","author":"de Mony\u00e9","year":"2005","journal-title":"Radiology"},{"key":"B32","first-page":"497","article-title":"Use of saline chaser in the intravenous administration of contrast material in non-invasive coronary angiography with 16-row multislice computed tomography","volume":"107","author":"Cademartiri","year":"2004","journal-title":"Radiol Med"},{"key":"B33","doi-asserted-by":"publisher","first-page":"W106","DOI":"10.2214\/AJR.13.10720","article-title":"Whole-body CT angiography with low tube voltage and low-concentration contrast material to reduce radiation dose and iodine load","volume":"202","author":"Kanematsu","year":"2014","journal-title":"Am J Roentgenol"}],"container-title":["Frontiers in Radiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fradi.2025.1709609\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T09:11:31Z","timestamp":1771924291000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fradi.2025.1709609\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,26]]},"references-count":33,"alternative-id":["10.3389\/fradi.2025.1709609"],"URL":"https:\/\/doi.org\/10.3389\/fradi.2025.1709609","relation":{},"ISSN":["2673-8740"],"issn-type":[{"value":"2673-8740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,26]]},"article-number":"1709609"}}