{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T23:06:57Z","timestamp":1792019217260,"version":"4.4.0"},"reference-count":29,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Triple-rule-out CT angiography (TRO-CTA) enables simultaneous evaluation of coronary, pulmonary, and aortic causes of acute chest pain, but conventional single-acquisition protocols may compromise vascular enhancement because of conflicting contrast timing requirements. This study evaluated whether a physiology-based sequential helical\u2013axial\u2013helical acquisition strategy could provide consistent tri-territory enhancement in emergency settings. Methods: In this retrospective single-center study, 71 consecutive evaluable emergency department patients (mean age, 66.6 \u00b1 17.0 years; 33 women) with undifferentiated acute chest pain underwent TRO-CTA using a structured sequential protocol (pulmonary, coronary, and aortic phases) guided by individualized test-bolus timing. Objective image quality was assessed using vascular attenuation, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR); subjective image quality was independently graded by two radiologists. Results: Mean vascular attenuation exceeded predefined diagnostic thresholds in all territories (pulmonary 546.7 \u00b1 237.8 HU [95% CI, 490.4\u2013603.0]; coronary 438.8 \u00b1 113.9 HU [95% CI, 411.9\u2013465.8]; aortic 604.3 \u00b1 190.9 HU [95% CI, 559.2\u2013649.5]). Diagnostic interpretability was achieved in all three territories in every technically analyzable examination without repeat contrast-enhanced imaging. Median subjective image-quality scores were 5 (IQR, 4\u20135) for pulmonary, 4.5 (IQR, 4\u20135) for coronary, and 4 (IQR, 4\u20135) for aortic phases; interobserver agreement was good to excellent. Mean total DLP was 461.5 \u00b1 122.5 mGy\u00b7cm. Conclusions: A sequential physiology-based TRO-CTA strategy is technically feasible in a tertiary emergency setting and provides consistent tri-territory enhancement. Because this was a single-arm technical validation study, prospective comparative and outcome-based studies are required to confirm its clinical impact.<\/jats:p>","DOI":"10.3390\/jcm15124640","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:49:01Z","timestamp":1781570941000},"page":"4640","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Sequential Helical\u2013Axial\u2013Helical Triple-Rule-Out CT Angiography: Technical Feasibility and Territory-Specific Image Quality in the Emergency Department"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-5558-0245","authenticated-orcid":false,"given":"Yeon-Jun","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Human Health Convergence, Graduate School, Kangwon National University, Samcheok 25913, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gi-Yong","family":"An","sequence":"additional","affiliation":[{"name":"Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Jin","family":"Cha","sequence":"additional","affiliation":[{"name":"Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7420-6269","authenticated-orcid":false,"given":"Sung Min","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Radiology, Wonju Severance Christian Hospital, Wonju College of Medicine, Yonsei University, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"National hospital ambulatory medical care survey: 2007 emergency department summary","volume":"26","author":"Niska","year":"2010","journal-title":"Natl. 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